Oceans of Hope is an unassuming little mastectomy boutique tucked into a nondescript building on the edge of a medical complex in Toms River, NJ. Not far from the Jersey shore, the boutique escaped catastrophic damage wrought by Hurricane Sandy on Oct. 29, unlike many other businesses along the coast. Still, Karen Donohue, CFm, CPC, had to shut down her boutique for 2 weeks afterward because it lost electrical power. She also donated 100 bras to a local shelter.
After talking with Donohue for a few minutes, you get the impression that she is an everywoman: a mom and a business owner who can kvetch over coffee, balance her books, lend a sympathetic ear to her patients, take the kids to soccer practice, come home and cook dinner and collapse into bed at the end of the day like the rest of us.
Armed with a business degree, Donohue was an office manager at Metropolitan Orthotics and Prosthetics in Toms River for 9 years, training with Mort Levy, CP. She became a certified mastectomy fitter in 2004. When she learned he was going to sell the business, she bought the mastectomy portion of it and opened her own boutique.
“Opening this boutique is the best thing I did. It has been so well received. It can be very clinical in the O&P world. This is feminine, it’s comforting; I have candles lit. You’re here by yourself; there are no men walking about testing their prostheses…it’s private and personal.
“When somebody’s had their breast removed, they’ve been through so much clinical stuff…this is about their mental health also, aside from just looking good. Some women go without breast prosthetics for years because they’re afraid, they don’t want to pull that trigger. They don’t know what it’s going to be like.”
Oceans of Hope is the only Medicare-participating boutique within a 100-mile radius and is contracted with major insurance carriers. “We’re in a senior community; we have to have Medicare,” Donohue said.
Donohue said patients may not realize they are entitled to post-mastectomy breast care through their insurance. A woman is entitled to up to six bras a year and a breast form every 2 years. “People don’t know that. So they go for years without.”
She is still hoping and waiting for Medicare to cover custom breast forms. “I think Medicare doesn’t feel that people over 65 should have a custom breast form,” she said, noting that Medicare does cover off-the-shelf forms.
Almost everything in this cozy boutique happens in the fitting room.
After the bare chest wall is scanned, patients are scanned wearing a prosthesis in their bra. That 3-D image goes to Radiant Impressions, and artists there custom craft the breast forms.
“It’s custom to every person. If you’re unilateral, it’s an exact mirror image of your remaining breast. And there are 44 skin colors,” Donohue said.
She said it could take 2 hours to plaster cast and lauded the speed and accuracy of scanner casting. She holds community events every 3 months in which she can scan up to ten women in one day.
“This technology maybe takes 20 minutes to scan everything, then it takes 4 to 5 weeks to get the completed form. They’re individually handmade, they’re beautiful. They refer to it as non-surgical breast reconstruction because it’s so lifelike.”
Donohue said the custom breast forms, while beautiful, are pricey. So she relies on off-the-shelf breast forms for 80% of her business.
“Not everybody is a candidate for custom breast forms. Some people put them on everybody; I don’t agree with that. A good candidate is someone who is at least 6 months out from surgery; they’ve completed their treatment, they’re at a stable weight and their incisions are healed. Someone who is not a good candidate would be someone whose weight fluctuates a lot. It fits like a puzzle piece into your chest wall. If you gain and lose weight, or you’re getting chemo or radiation you wouldn’t be a good candidate because your body changes.
They’re really wonderful for someone who is a difficult fit.”
Beauty and function
Donohue stressed the beauty of some of the mastectomy bras she carries but said that bras make up only a small part of her business. Donohue stocks 57 different products, including breast and nipple forms, bras and camisoles.
Trulife Aqua Flow, is an active form for swimming and working out. “The water goes right through it and it dries real fast,” Donohue said.
“We use that [Amoena Purfit] for women who are undergoing reconstructive surgery who are just starting the procedure, who are getting expanders that aren’t filled yet. They wear them over their breasts, either one or both, to even out their shape. It has a hollow back and cotton so you can make it as full or as shallow as you want it to be.”
The concave back of the Anita Care Active Ocean silicone swim form allows water to flow through it.
Trulife Impressions is, “the lightest breast form out in 30 years,” Donohue said. Some of the lighter breast forms are made with whipped silicone, she said.
Donohue said Radiant Impressions also does custom nipples. For one breast, she could cast the nipple as a mirror image of the remaining nipple and match the color. “For bilateral we could do nipples and use a surgical adhesive to put them on. That’s really psychological for a lot of women.” She also features semi-custom nipples, with a mix and match assortment of projections, shapes and colors.
From surgery to fitting
Donohue acknowledged that the O&P industry, specifically regarding breast care, is changing, but she thinks surgeons don’t actively promote options other than reconstruction. “Surgeons are surgeons,” she said. She sees a real need for breast surgeons to work with mastectomy fitters to provide patients with alternatives and follow-up options for care.
She said she sees a lot of women with failed reconstructions.
“More younger women have reconstructive surgery done,” she said. “Some surgeons say you have to wait a year. Some put expanders in right away. They get a reaction to the expanders, they get an infection, they have to remove the implant. But I think older women who have been with their husbands a long time say ‘I don’t need it.’ I think if you have a really good fitting bra and a good prosthesis, you’re fine. You do need to wear a prosthesis; you don’t want your shoulders to roll in.
“My goal is that the patient should come here before surgery. You build a relationship with them so it’s not as scary for them, so they know that once they’re healed they can come back and choose their post-surgical garment and prostheses,” Donohue said. A better standard of care would require a pre-surgical visit to a mastectomy fitter or boutique to obtain post-surgical garments and a post-surgery camisole, which Donohue said patients are entitled to through insurance. The advance preparation would allow women to put aside concerns about these items after surgery.
“After surgery, when they’re home, [patients] have drains; who wants to go to Walmart and buy a camisole? Or we should be able to go into the hospital after their surgery a day or 2 before they are released and give them a bra that fits them.”
Not all business
Donohue spends a lot of time with her patients. “You form lifelong relationships with these women,” she said. Her business doesn’t stop at her door, though. Chapoutot, a health care consultant, assists with marketing and helps Donohue with community events. Oceans of Hope participates in various women’s health expos and fairs and is featured in the survivors’ tent at the Making Strides Against Breast Cancer annual walk, sponsored by the American Cancer Society. Donohue also takes her business directly to surgeons.
But it’s not all about the business with this business owner. It’s about making women feel cared for during a difficult time, and creating a space in which they can feel comfortable.
“It’s not about the money. I’ll never be a millionaire. It’s about helping people. I’m passionate about breast care.” — by Carey Cowles