Women's Health

Each year more than 180,000 women are diagnosed with breast cancer, according to the National Cancer Institute (NCI). It is the most common cancer among women excluding skin cancer, and the American Cancer Association (ACA) estimates approximately 41,200 deaths due to breast cancer will occur in 2000.

However, early detection and treatment are leading factors in minimizing cancer fatalities.

The most common treatment method for breast cancer is modified radical breast mastectomy, which involves the removal of the entire breast and some of the underarm lymph nodes. Removal of a breast can cause a woman's weight to shift and be out of balance. This can cause discomfort in the neck and back, and it is important that women are aware of the many products that provide comfort available to them.

Products for Comfort, Self-esteem

There are many post-mastectomy products created to maintain a woman's balance while providing support for the back and neck. While many women face traumatic experiences of post-mastectomy anxiety, many manufacturers and home medical equipment (HME) providers are trying to meet the needs of these women through products like breast forms and bras designed to help patients ease back into a sense of normality and comfort.

Breast forms are designed to be worn externally and to closely resemble the natural appearance, feel and weight of a breast while restoring feminine shape and a feeling of balance. Wearing a breast form can help prevent the development of spinal curvature, neck and back pain and shoulder drop as well as help restore a woman's self confidence helping to improve her quality of life after breast surgery, according to doctors.

Post-mastectomy bras are also very important due to the effects of a mastectomy. For example, the shoulder has a down and inward tilt after surgery and a regular bra has a strap that will grab the shoulder, but in a post-mastectomy bra, the strap is made toward the neck so the woman can hold her shoulders back.

"I think sometimes the bra is forgotten. It has to be tastefully done to appeal to women with varying needs. Regular bras don't always get the job done in a healthy way," said Louise Rose, vice president of Jodee Bra, Hollywood, Fla.

Manufacturers realize the changing needs of patients and are constantly developing new ways to make post-mastectomy products more comfortable for their customers. Needs that are being addressed include the weight and heat of prostheses, so many companies are developing ways to make breast forms lighter and cooler.

"We use all-fabric, uniquely weighted breast forms without silicone, plastic or rubber to make them more breathable and alleviate shoulder discomfort," said Stacie Neely, president, Bosom Buddy Breast Forms, Boise, Idaho.

New silicone technology is paving the way for manufacturers to design breast forms that are lighter, which ease shoulder and back pain.

"This silicone is an entire new process which allows the breast form to weigh 20-25 percent less than a traditional weighted silicone form, yet it is still taking up the some volumetric space. It's just a lighter, all around material," said Barbara Ettenger, product manager for breast care, Camp Healthcare, Atlanta.

Some advantages of these lighter forms are that in addition to relieving pain in the shoulders and back they also allow women to wear the product longer.

"This is intended for women who would maybe not wear their weighted silicone form the way they should, this is slightly lighter, and hopefully they'll wear it more and be compliant so they'll receive the benefit of a good balance," Ettenger said.

Ettenger also said this is a good option for women who suffer from lymphodema, which is a build-up of fluid under the arm that can cause swelling because the lighter forms reduce pressure on the shoulder and clavical area, which is important for proper healing, according to lymphodema experts.

Other companies, like Biomedical Horizons Inc. (BHI), Jackson, Miss., try to reach a variety of women through different products such as wonderstraps, which are hypoallergenic pads that women can put their bra strap through to prevent slippage. Linda Donahue, vice president of BHI says it is important to remember that every woman is an individual with individual needs.

"We try to cater to as many women as possible. Wonderstraps can be worn by women who are very active or by women who simply require a sturdier strap," Donahue said.

Being aware of surgical procedures is also very important, according to Neely.

"We maintain ongoing research in the brassiere market as well as the changes in surgical techniques," she said.

She also said it is important for HME providers to have a good knowledge of bras, changing styles and surgical techniques so they can provide quality service to their customers.

Sensitivity and Dignity

While manufacturers are attempting to answer the needs of post-mastectomy patients, they and HME providers are becoming more concerned with psychological and emotional issues women face when searching for products. Patricia Sobcznski, educational director for breast care, Camp Healthcare provides educational training to its sales staff and HME providers on maintaining quality customer service when working with post-mastectomy customers.

"Our employees attend the same post-mastectomy fitter certification program that is offered to our customers. This program offers more than fitting techniques and knowledge, we also focus on the survivor and how to create a comfortable environment for a good fitting experience," Sobcznski said.

Camp Healthcare also provides a manual that includes resource information complete with names and addresses of support groups.

"We also have our BATA (Breast Awareness Teaching Aid), which is a silicone breast form with lump configurations and is designed to aid in teaching women how to perform proper self breast examination," she said.

She recommends that providers respect the dignity and privacy of their customers by having a loose fitting robe available so the woman is not exposed for too long a period between measuring and fitting. She also recommends that the store have a comprehensive inventory available and that providers are aware about local support groups and have information on hand about services and products.

Camp Healthcare also suggests learning about the different product choices available and how to differentiate one from another.

Marketing

HME providers rely on many methods to market products such as newspaper advertisements, Web sites, support groups and physicians; however, many have found that word of mouth advertising seems to be the most effective.

"The growth of our store is due to word-of-mouth. Our customers are our best advertisement because they appreciate the respect and individual attention they receive," said Brenda Mitchell, owner, Silhouettes, Dayton, Ohio.

Vickie Jones, owner, Women's Health Boutique, Longview, Texas, also said spreading the word through customers is effective; however, she advertises consistently in the newspaper through a question and answer format.

"We ask questions that we believe women want the answers to or that customers in the store have asked," Jones said.

She also said she has heard from many nurses and physicians who follow her questions on a weekly basis.

Jones feels these marketing strategies are effective because each one reaches a new customer whether it is a woman who has recently had surgery or a woman who has worn breast forms for years.

"Women that are active in support groups and are very open with their surgeries refer the most customers," Jones said.

Although manufacturers and HME providers are becoming more aware of the sensitive needs of their customers, Mitchell finds that insurance companies have very strict guidelines on the types of products they will cover.

"In the past, women had more choices and felt more in control of their purchases. Insurance companies cutting costs have substantially decreased the items we can offer that are covered through insurance," Mitchell says.

Jodee Bra Vice President Louise Rose believes a problem lies in reaching out to smaller communities.

"I think the whole idea is to expand their providers thinking. Reaching out to little communities where a lot of women are closeted due to lack of resources," Rose said.

Rose also said a store can improve upon existing sales techniques by doing in-home fittings certain days a month to better service rural areas where there might not be a store convenient for them.

"Its important to think of ways to get these women in or to go to them," she said.

Emotional Support

While advertising is important in making customers aware of post-mastectomy products, both Jones and Mitchell maintain it is the environment they provide that gives their customers a sense of comfort and support while shopping. Women need individual attention and sensitivity while shopping for products and many HME providers attempt to put their customers at ease as soon as they walk in the door.

"Greeting is critical to make her feel like she's okay. I've had customers come in and the reason they waited so long before coming in was because they were afraid of the experience," Jones said.

Providing a supportive environment is important because women react very differently to their surgical experience.

"We never hurry the customer, and if she feels the need to talk and discuss her experience, we are willing to listen," Mitchell said.

Jones said sensitivity and respect are key essentials to serving their customers.

"Our whole goal is to build comraderie and a trusting relationship with that woman where she has complete confidence that we can meet her needs," she said. "Some retailers work with their referring physicians by providing 'pre-surgical' visits. This allows the patient to see the products that will be available following her surgery. This visit also starts the building of the relationship between the customer and the fitter," Sobczinski said.

Mitchell also believes education is an important aspect in serving mastectomy customers. Her clerks are all certified mastectomy fitters and they all attend fitting seminars given by vendors throughout the year.

"We find there is always something to be learned and we especially enjoy interacting with other ladies in the same field and sharing our concerns," she said.

Jones said while the environment is important but also the working relationship during the fitting process. They measure their customers for a bra first to ensure a good fit of the existing breast, and then they try a variety of breast forms until the customer finds a good, comfortable prosthesis. Jones also recommends that after the bra and form fitting, the customer put them back on herself so she knows how to do it properly to get the same look as in the store.

"It's the little things that make the process go smoother like teaching the customer how to position her breast in the cup or to take in a little tuck with a needle and thread to get a good fit," she said.

As the incidence of breast cancer continues to rise, post-mastectomy products will be needed more and more. Manufacturers are constantly improving upon existing products to answer the physical needs of their customers to ease the transition during the post-surgery trauma some patients experience. HME providers can take the next step by providing quality products and supportive environments to help improve their customers' quality of life.

This article originally appeared in the March 2000 issue of HME Business.

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