Elisa Lawson, a Certified Mastectomy Fitter at Mercy Medical Center talks about breast forms and what they mean to some women.
Interview conducted by Ivanhoe Broadcast News in December 2018.
Do you have any medical background?
Elisa: I have been involved in Breast care for women most of my working career. I taught Breast feeding classes as well as being a bra fitter in finer Department stores including Nordstrom. Owning The Women’s Health Boutique has been a natural path based on my years’ experience fitting women for regular bras and teaching Breastfeeding.
Talk to me a little bit about the way this was done five, ten years ago.
Elisa: It was probably about twelve to fifteen years ago when the first custom was introduced, it was actually designed by the husband of a woman with breast cancer and he happened to be a dentist. So this whole molding process he kind of implemented that in to the custom. It was difficult. It was a two-hour long process wrapping women in plaster trying to get an image of what their chest wall looked like as trying to get an image of what the existing breast or what the breasts were going to look like afterwards. We would cast them or we would wrap and then we’d wait for that cast to dry. We’d ship it off to the manufacturer and it would be hand carved according to that mold. And it was something that was discouraging for some women because of the time element and physical limitations that made it incapable for some women to stand still for two hours to go through it. So as much as women liked the idea of it, it wasn’t the most popular way to get to the finished product. And then they started doing it using a computer and that was probably about seven or eight years ago. There was a woman working for the company on the east coast who literally went up and down the east coast by appointment only. But again it wasn’t real practical because you had to set up appointments, there were sometimes cancellations and different kinds of factors that would interfere with keeping that appointment and they you’d have to wait for that person to come through again with her computer and do it again. We really weren’t able to address a lot of women and to take care of their needs in a reasonable amount of time. A new company American Breast Care decided to do it using an iPad and training retailers to do it themselves. We fortunately were selected in one of the first groups that they were giving the iPad and training. And it allows us to be able to do the scanning process on demand pretty much. There was some paperwork that you needed to do as far as insurance goes but for the most part if somebody comes in and they have a little bit of time and I’m able to put them in on my schedule that day that we can scan them and you know get them setup for the process without having to come back.
Walk me through the process of what you have to do putting the markers on. How long have you been doing It?
Elisa: I have been doing it myself here for two years. And we’ve had a lot of success because we have a lot of travelers here. A woman can come in having driven two or three hours to her appointment and we introduce the idea of a custom to her and we can do it that day. So it’s been really, really good for us and it’s been especially good for the patients.
Talk to me about how you physically go about doing the measurements, instead of wrapping them in plastic.
Elisa: Surprising as much as there is a lot of technicality involved in doing the process, the most important part of the entire process is getting the right bra. The first thing we do is fit them in a bra that they are both comfortable and that gives them the look that they want. And sometimes that takes longer for us than anything else. The nice thing about the custom is it doesn’t have to be worn in the pocket of the bra like a traditional prostheses does. Women actually have the option of going out and doing some of their own shopping, finding bras that they like and then bring them to me. And then I often try to help them decide which one really is the best bra because there are fit factors involved in a bra and not just the esthetics of a bra. I help to make them make a decision on a bra that really will give them the best outcome for the custom as well give them the most comfort on a day to day basis. But the beauty of it all is that they can still go out and go the stores and buy a regular bra the way everybody else does because they’re not utilizing the pocket of a bra anymore.
Once you’ve settled on a bra that works talk to me about how you physically go through and getting the measurement and getting everything that works for a woman?
Elisa: The process involves both photographs and scanning. The first thing that we will do is put some landmarks on her body which are little puffy pieces of cotton which will help us to line up every one of the scans and everyone of the photographs to make sure that one is sitting on top of the other in the exact same position. We’ll take a series of photographs some with her hands on her hips, some with her hands down, some with her sitting and then we’ll move on to scanning where we’ll take and iPad and just kind of scan around her moving from the right to the left side and creating a virtual body cast with the scanner. And we’ll do that in a couple of different positions.
Now you have both the front and the chest wall that you’re able to measure, tell me about that?
Elisa: The first thing we’re going to do is get the images with what she wants the finished outcome to look like. How big she wants to be or trying to get her symmetrical to a breast that she still has. And then we’ll take the bra off, take off the prostheses that’s creating that look and that’s just an off the shelf prostheses. And then we’ll start scanning and doing the photography process all over again with the chest wall. Because the beauty of the custom breast form is that it’s recreating on the back of the form exactly the image of her chest wall so it fits like a puzzle. So we want to be able to get you know, some accuracy in what the back of that form is going to look like.
How are you able to do that?
Elisa: Just using the scanner because the scanner is going to pick up of the dimensions, all of the nooks and crannies, all the crevices, all the pockets of skin that are left on the chest wall. That’s what the back of the form will like and the front of the form is going to look exactly the way she wanted to look when she put that bra on in the beginning.
Is it a matter of comfort or is it a matter of this is something that’s not going to move around, that once it’s in place you’re going to be even?
Eliza: You’re wearing the custom breast form for a lot of different reasons. There are women that choose a custom breast form because let’s say they’re a triple D or let’s say they just have a very small frame and a larger breast and wearing a traditional silicone form is heavy and somewhat uncomfortable for some women there are many women that wear traditional forms and are perfectly happy in those forms. But we get women that are having issues with the way the form is fitting, the way your form is feeling, the way it may be shifting and some of this has to do with how she’s willing to wear her bra because if you’re fill breasted you have to wear your bra snug. And a woman sometimes is not comfortable wearing her bra snug enough to support the weight of a traditional form. So we put her in a silicone foam form and these forms are still silicone but they’re silicone foam and they’re greatly reduced in weight. It’s going to immediately give her that kind of comfort. We have women like Helen who have so many chest wall issues and being bilateral we’re trying to get her symmetrical using off the shelf forms but she has two entirely different issues going on, on each side of her breast. So we’ve come close but we’ve never come as accurate as what we’ve been able to do when we do a custom breast form. For some women, they’ve had reconstruction, they’ve had failed reconstruction, they always wanted to be reconstructed and it’s no longer an option for them and they want the absolute best, most comfortable, most symmetrical outcome and the custom is the only way that we can do that. We have women that just choose customs for lots of different reasons. We have women that choose prostheses for lots of different reasons. But it’s really nice to know that we are actually able to give them the absolute best form that’s on the market. They’re going to be able to choose skin tones that match their tones better, they’re going to be able to choose nipple diameters, they can project the nipples, they can flatten nipples so we can give it characteristics that you can’t do in a traditional form. And for some women that kind of fills that void of not being able to have a breast.
Why is this important?
Elisa: I think it’s important because some women have so many emotional issues that are attached to losing their breast. And it’s just been hard for them to deal with coming in and getting something that’s in a box. You just take it out of the box and you just stick it in their bra and you know there’s many women that that’s perfectly fine but there are those few women that their breast just meant more to them than that. And so they want to be able to create something that when it’s done there is no one else that can wear the breast form comfortably and as perfectly as what they can so they have this kind of emotional attachment to it too.
In terms of insurance is it covered?
Elisa: It’s covered by most insurance and we’re still working on Medicare and we’re hoping that Medicare is going to approve it in a short period of time. Most private insurances will cover it and they will cover it at the same level that they cover anything else. Whether it’s an eighty/twenty plan, ninety/ten. Some insurances will require prescriptions but they’ll also require some special paperwork to identify that they really need a custom and that they just really can’t use a traditional form. But for the most part it’s a fairly easy process. I think the insurance companies are really starting to recognize that this is what women want. It’s becoming easier and easier for us but it’s still expensive. They’re three thousand dollars apiece and an eighty/ twenty plan still means that your twenty percent of three thousand dollars and times two if you’re bilateral is a huge amount of money to pay for something. But I think that the manufacturers have stepped up and they’ve created a product that women are willing to spend that kind of money for if they need to and there are companies that are paying for it at a hundred percent. So we’re seeing more and more women being able to get the product.
Is there anything that I didn’t ask you that you would want people to know?
Elisa: The one thing I did want to make mention is that there are women that have worn a traditional form and very quickly realized that they don’t like that form. And they can come back in a very short period of time and still get the custom. It can be worn swimming so it’s the form that you can take with you when you’re on vacation and take it swimming, you don’t need a special swim form like you do with some of the other forms that lose their warranty when they’re worn swimming. This is actually made for everyday wear, all purposes.
Would hold up in the shower?
Elisa: Well I mean there are those few women that don’t part with their breast forms when they’re sleeping at night. And they’ll get a very comfortable bra to wear they just can’t part with not having breasts. I think it’s such an awesome form for our women who is really big breasted who has to wear a form that is a size fifteen or sixteen. Or, the women who is so full breasted that they don’t even make a form that gives her the symmetry that she needs. I mean there are a lot of women that everything that you see in this room is going to work for them and they’re going to be perfectly happy. And there are some of these women it just breaks your heart because you’re reaching for everything that you know is available and you still can’t myself look in the mirror and say, well that’s good. Like they’ll look in the mirror and it’s better so they take it as good enough. But I know I can do better than that. And sometimes the only way I can do better than that is by offering them the custom. And I don’t think its right for everybody. It’s very different feel than a traditional form and women who have been wearing form for a long time are used to that weight, they’re used that kind of softness that comes with silicone gel, this has more of a firmness it’s lighter but it is a firmness. So it’s just nice to know that we have so many options that without reconstruction we can find something that’s going to take care of every single person’s needs.
Elisa: This is the selection of colors that we have and this of course you saw Helen’s form but this kind of the sample that we use. And then there are also different size nipples that we can use and we can even change those diameters if we need to too. But it’s nice to stand in from of the mirror and take the colors and put them up to your skin and find something that’s going to be close, especially if you’re wearing a lacier type bra. If a woman has found a lacy bra because you can see your skin through the lace and when you’ve got a form on and then you’ve got a different skin tone on the other side you look in the mirror and you’re like wow, this looks great but I’m looking really different on one side than I am the other because my skin tones aren’t matching.
Elisa: I say okay here it is stand in front of the mirror and start holding up color you know like up to your skin until you find something that comes the closest to your skin tone. And then you know do you want your nipple flat, do you want it projected. I usually discourage that because it’s always projected. And then choose a nipple tone. If you still have a breast you can try and match up your nipple tone on the other breast. If not like with Helen she just chose a close a color for both of them you know. It’s really very, very unique and it’s kind of fun to work with people with it because they actually get excited. And I did one I guess about two months ago for a lady down on the shore, I sent it to her because I wasn’t going to get down there fast enough to get it back to her. And she called me because it wasn’t completely symmetrical. And she had gotten one done five years ago and she absolutely loved that form. And this one they just didn’t do it right. I went down I rescanned her, I did everything I could to try and do what was necessarily for them to create it again and I was doing the paperwork she was crying, I mean sobbing and I turned around and I’m like are you okay because she was behind me. And she’s like I was so afraid that you weren’t going to see the imperfection that’s in it. And I said, Tammy I’m telling you right now even if I didn’t see it I was going to do it again until you were happy. But she was so attached to that original breast form that she had five years ago that she could not part with that and start wearing the new one until it was as perfect as that first one was. I had never seen anybody that emotional about it before but it was pretty impressive to see how attached people get to something like that.
END OF INTERVIEW
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