Carter explained to Nulph that new prostheses for post-mastectomy women have changed over the years and Nulph could get her womanly look back. It was exactly what Nulph wanted. "I can put them away in a drawer at night and not have to worry about them," she says with a laugh.
Mary Jane Roop, 46, of Thurmont, Md., was 43 when she was diagnosed with breast cancer in April 2005. On Aug. 30, 2005, she underwent a double bilateral mastectomy.
Roop says it was personal decision to remove both breasts. A C-cup prior to the surgery, she says she felt "completely flat-chested" when she was sent home with a pair temporary soft cups to fill out her bra.
But Roop, like Nulp, didn't feel that reconstructive surgery was an option for her. "The only person who will see you are you and your husband," she says. "Why put yourself through that all that physically? ... And it's not always successful."
Roop met Carter at Ability's Frederick, Md., office. She says Carter "was very compassionate and very knowing" when it came to explaining the prostheses at the company's Frederick office. With new advancements, today's prostheses feel like real breasts and the accompanying bras come in a range of colors. She says Carter showed her the examples she could wear. "It was kind of surreal, these boobs in a box," she says with a laugh.
Finding the right fit
A registered nurse, Carter says to be a CFOM she had to go through "a good bit of training" at St. Petersburg University in Florida. She received her certification through the American Board for Certification in Orthotics, Prosthetics and Pedorthics Inc., which will be government regulator for all CFOMs in 2009. Carter is one of the few fitters in the tri-state area, and the only one for Ability, which also has offices in Frederick, Md., Gettysburg and Exton, Pa.
During the three years she's been with Ability, Carter says she seen many women who are going through the same experiences as Nulph and Roop. "I'm seeing them as early as six weeks after the mastectomy," she says, "but we see them when they're mentally and physically able to."
Carter says when women first come in the office, it's more of an exploration. "They're really her first to see what I have to offer," she says.
There are two basic types of prostheses that are available: off-the-shelf and custom.
Off-the-shelf are basic prostheses that are fitted to the patient and cost about $300 for a single breast form. A woman wears a specially made mastectomy bra, which includes a pocket in the cup where the prosthesis would be placed. The bras cost about $40 each.
Carter says it takes about three days until a woman can get an off-the-shelf prosthesis. And she, says, 99 percent of it is a covered benefit through insurance.
A custom prosthesis costs about $3,000 each and takes about three week to a month for the order arrive.
With the custom bra forms, Carter says she uses a hand-held laser scanner that she waves over the woman's chest walls. The scanning allows the technician make a custom breast form from a digital imagery. This high-tech approach allows for a more flush fit of the prosthesis.
There are several styles of custom breast forms. In one, the back contains a magnet. The woman attaches an adhesive disc, similar to those used during an EKG, with a magnetic front. The adhesive part sticks to the chest wall of the patient and the magnetic part lines up with the breast form. "They don't have to wear a bra," Carter says.
And just like the women themselves, the breast forms come in different shapes and sizes. Women can have the option to find a prosthesis that looks like her own breasts or find ones that she feels looks better or are even a larger cup than what she had pre-surgery. Custom breast forms have even more life-like features such as a nipple and areola.
With the new advancements with the material, Carter says the prostheses are lighter. "Because they are made with whipped silicone, it decreases the weight by one-third," she says.
Carter says patients who have had a lumpectomy can also get a partial prosthesis. "It helps them feel symmetrical and more whole as a person," she says.