Custom Silicone Breast Form Facts
The production of a custom breast prosthesis starts with sophisticated equipment that scans your chest wall. Measurements are taken and sent to production. The finished product fits your chest wall like a custom puzzle piece. It is truly a combination of art and science.
You can choose from multiple skin tone colors, nipple colors, and projections (perky or flat!), add 3D vein markings, and a beauty mark or two. Depending on your chest wall surgery site, you may never be happy with the fit of anything other than a custom form.
Custom forms can be worn directly against the skin and do not need a pocketed bra. You can usually wear these for your active lifestyle instead of having any additional breast forms.
It is possible to have a custom shaper and/or nipple made, depending on your personal needs to achieve symmetry.
Be certain you fully understand the intention of a custom breast prosthesis. Just like any other prosthesis, this product is designed to mimic a silhouette that looks symmetrical while wearing your clothes.
Medicare does not cover a custom breast form. They only pay for what is ‘medically necessary’ and Medicare does not recognize that a custom form may be the only choice for you; they only recognize the basics as essential. Other payers may pay all or some of the cost.
There are multiple stages of production for a custom form, done by hand, and I have often wondered why these custom forms are not more expensive than they are! I have been awed by the talent and dedication of the team that produces this product. They are dedicated artisans.
Custom forms are pricey, but you are worth it! You will most likely have some out-of-pocket expenses. Some of my patients asked their churches for financial assistance, held bake sales and other fundraising events to help with the cost or asked for a monetary gift for birthdays and holidays to defray some cost.
Your insurance will probably insist that you attempt to utilize an off-the-shelf form first, so be prepared to get additional documentation from your physician if you need it. Be sure to find out if your insurance requires you to get a pre-authorization to obtain this form. In the past, pre-authorizations were rarely needed for breast care products.
But the reimbursement rules change every day and you should ask your provider. Be sure to document the call with date, time and the name and reference number of your call. Your dealer should also be checking your insurance for reimbursement criteria.
For patients who have severely deformed chest walls following mastectomy or as a result of multiple surgeries, an off-the-shelf form may never achieve the desired symmetry. An aging natural breast with a reconstructed breast presents unique symmetry issues, which can sometimes best be resolved with a custom form.
Medicare does not cover custom breast forms, but other payers often do. Additional documentation may need to be submitted regarding the patient in order for them to have a custom prosthesis approved by their insurance provider.
Benefit coverage changes constantly and is different with every payer and state. Pink Ribbon Plus cannot be responsible for changes in coverage. All information is given with the sole intent to educate the client and help them understand post-breast cancer diagnosis insurance benefits when pertaining solely to post-op garments, external breast forms, bras, wigs, and skin care products. All products must be approved by the physician before using.