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Inequities for Mastectomy Patients in Ontario: Reconstruction vs Prosthetics

breastprosthesisby Karen Irwin, CKN Project Co-ordinator

 

Survival After a Mastectomy

 

Despite the recent increase in breast cancer incidence in Canada, improved screening techniques have allowed more women to survive the disease. What does survival look like for women facing mastectomy? Full of gaps and inequities in the standard of care provided by our health care system, says Todd Kubon, Craniofacial Prosthetic Unit, Sunnybrook Odette Cancer Centre, Toronto. The post-mastectomy decision process includes choices such as

 

  • surgical reconstruction – no cost (implants or autologous tissue reconstruction)
  • conventional (stock) or custom prostheses – out of pocket
  • doing nothing at all

 

Reconstruction is covered, prosthesis is not?

 

Financial Inequities: While breast reconstruction is covered through a national health care program or private insurance, the Ontario Government offers a grant to mastectomy patients of only $195 for either stock or custom breast prostheses. In Ontario, a stock prosthesis can cost $200-$400, while a custom prosthesis can cost over $5000.

 

Breast Prostheses Compared to Other Prostheses: Furthermore, research shows that 90% of mastectomy patients will use a breast prosthesis, either permanently or temporarily. Most other prostheses – leg, arm, teeth, facial – are customized to fit the individual while the standard of care for breast prostheses is to use a “stock” or “off the shelf” breast prosthesis.

 

Breast Cancer Survivors Weigh in on Conventional (stock) vs. Custom Prostheses

BreastProsthesis-StockConventional: “The women who described their experiences with a conventional breast prosthesis spoke about difficulties with comfort (“it is so hot I can only keep it on for a few hours at a time”), the fit and shape (“it does not fit properly even though I got it fitted at the store…. I still have to stuff it and work with it…. and there are just not enough sizes”), and appearance (“I can’t wear a see-through bra because the prosthesis is not the right colour”; “it helps to create an illusion, but you need to have clothing on for it to work”).”

 

BreastProsthesis-CustomCustom: “Overall, the women who had experienced wearing the new custom breast prosthesis responded that many of the issues they had experienced while wearing a conventional prosthesis were markedly improved. They found the custom prosthesis fairly comfortable and light in weight (“I like the lightness of it—it feels like it’s me”), better fitting with clothing (“it fits so well that I can hardly believe I am wearing it”), and natural looking (“I do not have to think about how it looks. It is so realistic”). Women talked about the psychological benefit of the custom prosthesis: it helped them feel less like a “victim” and more “normal.””

 

Todd Kubon, Craniofacial Prosthetic Unit, Sunnybrook Odette Cancer Centre, Toronto tells us:

“It is often easier for women who have had a mastectomy to have a breast implant procedure….than it is to have a custom breast prosthesis made. Women who elect—for either personal or health reasons—not to have additional surgery to restore their breast contour are therefore faced with the burden of having to pay out-of-pocket for a prosthesis.”

 

Why Not Choose Reconstruction Surgery? Studies show only 10% of mastectomy patients elect to have reconstruction surgery after a mastectomy. Why? The reasons can be psychological or health related. Some women don’t feel comfortable taking the risk of additional surgery after the emotional and physical turmoil they experienced with their cancer treatment; some women cite uncertainty about the esthetic outcome of the surgery as a reason; and age has also been shown as a contributing factor (older women tend to choose against reconstruction). Radiation treatment can be a health factor that can delay the option to have reconstructive surgery. These circumstances only serve to emphasize the importance of breast prostheses to breast cancer survivors.

It is clear that these inequities – of accessibility, quality and financial assistance – in the breast prosthesis service in Ontario need to be re-examined. For many women, the acquisition of a custom breast prosthesis was, “the most positive experience throughout my cancer journey.”

Updated Commentary: Custom breast prosthesis as a rehabilitation option for mastectomy patients

Download PDF:  Sunnybrook Custom Breast Prosthesis Brochure

 


 

 

The Sunnybrook Odette Cancer Centre is offering a new evidence-based custom made breast prostheses service as an alternative to stock breast prostheses and reconstructive surgery that every cancer survivor should know about. Our process will recreate the shape and appearance of the absent breast/s and is available to referred patients who have had a mastectomy or lumpectomy, including those who have also had radiation therapy. Custom-made breast prostheses are soft, lightweight, custom-coloured to skin tone, and remain securely in place against the chest wall, which allows the patient to return to wearing most clothing styles and activities.

 

For more information please call 416-480–4254 or follow the link to our website http://sunnybrook.ca/content/?page=custom-breast-prosthetic-unit

 

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One Response to Inequities for Mastectomy Patients in Ontario: Reconstruction vs Prosthetics

  1. pamela says:

    Every woman in Ontario should read the above article. I myself was not aware I would not be extended the same financial assistance extended to those that decided to have reconstructive surgery.

    In under a month I have went from diagnosis to mastectomy of my right breast. I’m very grateful to my surgeon and staff for their quick action. I am and remain disgusted at being treated at a highly emotional time so shoddily by our health system. Surgery was done as day surgery. In the recovery room I was handed a plastic bag with supplies and told to report to  a Wound Care Clinic in the morning for the dressing to be changed. I was extremely upset at the prospect of having to do this. Later in the evening I did receive a call  saying they had decided they would send a nurse to my home for a day or two. But as soon as I could I was to to go to the clinic.  Now I read this article and feel yet again beyond disgusted. At 62 I don’t want reconstructive surgery, but nether am I well off financially. The $195 every two years towards an off the shelf prosthetic is a slap in the face compared to what surgery would cost the health system. The chance of having a custom made prostheses simply out of my reach.  Above all the Ontario government are pushing woman towards reconstruction like it or not, or expect little to no financial aid from them.  Downright disgusting.

    I wonder right now why I have not read anything in the news papers about this blatant inequality, and do thank Sunnybrook hospital for trying to bring this matter into the public eye.

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