To properly train a mastectomy fitter, you must understand the physical and emotional challenges that a woman experiences. The diagnosis of breast cancer can dramatically impact a woman's life, and the lives of those close to her. It is natural for patients, family members, and friends to have many different and confusing emotions.

Many women who have breast surgery are worried that the changes to their bodies will affect not only how they look, but how other people feel about them. They may worry about holding a job, caring for their families, or starting new relationships. Concerns about sex can be upsetting, too. Support of loved ones is important.

When a woman loses a breast, or even part of a breast, she can experience emotional feelings associated with the loss. In the beginning, "why me" and disbelief may loom large in her mind.

Denial can manifest itself with thoughts such as, "I'm not sure I needed this surgery. I've read about mistakes in pathologists' reports." She may find herself bargaining, "Well, if I can just live to see my children grown." It is perfectly normal to feel anger, and she needs to learn how to release this anger in a constructive way.

Depression is often experienced as she copes with the loss. She can be helped by talking of the future. "Where are you going on vacation?" and "Tell me about your son's upcoming wedding" are some examples.

Acceptance almost always comes. She gets on with her life, realizing she is the same person she always was—a wife, mother, daughter, or friend. As a fitter of prostheses and bras, it is important to be aware of, and be sensitive to, the feelings of the customer. A professional, loving, and caring fitter can help patients get quickly back into the mainstream of life.

A professional fitter empathizes and realizes that her patient may be coping with life-threatening experiences. As her fitter, avoid feelings of pity, but instead lovingly help her in a professional manner. Educate the patient as to her individual fitting needs. Help her understand the product and what services are available for her future needs.

To help her relax, ask her questions that she can easily respond to, such as "When did you have surgery?" or "Who is your doctor?" "Has the doctor said you can be fitted?" You may say as you help her undress, "Let me determine what your needs are, and I'll show you what is appropriate." As you look at the label of her bra, you might ask, "What size bra do you usually wear?"

At this point, you may determine the bra size needed. You must fit the bra before you fit the prosthesis. Then refer to the prostheses fitting chart and choose one to start the fitting.

Educate her as you fit her. Informed customers will trust you. A fitting usually takes 20 minutes to an hour. However, take as long as necessary to satisfy your customer's needs.

WHY WEAR A PROSTHESIS?

When a woman loses a breast, she loses an appendage that hangs off the body. The body is the center of gravity, and losing a breast, which is outside the center of gravity, causes an imbalance.

There is a downward and inward tilt of the shoulder after losing a breast, and if a woman goes too long without compensating for the lost breast, one shoulder blade can become higher than the other. When both breasts are removed, the down and inward tilt of both shoulders can cause the woman to carry herself in a manner that creates a concaveness of the chest wall. Balance is restored by wearing a prosthesis, and she will then hold her shoulders back—taking the unbalanced pressure off the shoulders and back.

We are balanced side to side and back to front. Weight for the bilateral person does not matter as long as it is balanced weight. As weight is restored to the bilateral wearer's chest wall, she automatically holds her shoulders back. In addition to restoring balance, a prosthesis restores the natural silhouette of the body, which contributes to emotional health.

DIFFERENT KINDS

There are many types and shapes of prostheses on the market today. Most, however, are made of silicone. Silicone is sand that has been heated to a high temperature, and oil has been added to make it soft. It is very much like the natural breast, and takes on the temperatures of the body. It is not affected by chlorine or salt water.

There are silicone prostheses available in regular weight, 25% lighter, and 35% lighter. Due to a lack of education among prosthesis wearers, there is a misguided notion that breast forms are too heavy. This causes some women to look for and wear prostheses that are too light, and do not restore the necessary balance needed for good health.

It is important to explain to the wearer that the farther something is from the body (center of gravity), the heavier it feels. Thus, holding a prosthesis in the hand (which is probably 10 to 12 inches from the body) makes it feel much heavier than it is when it is worn properly, close to the body, balancing the weight of the natural breast. There should never be any feeling of weight when wearing a prosthesis.

THE RIGHT BRA

A prosthesis is only as effective as the bra that carries it. Wearing the right bra, properly fitted, will help the woman feel comfortable, healthy, and feminine.

There are many bras on the market, but only a few that carry a prosthesis properly. Surgical bras are specially designed for this purpose.

A bra should have a pocket in it to hold the prosthesis in place, and allow air circulation between the prosthesis and the chest wall. A bra should have a good separation at the breast bone, so the bra can touch the breast bone easily. Touching the breast bone assures the proper containment of the natural breast, and helps hold the prosthesis close to the chest wall. The bra should always be centered.

There should be an ample, soft, stretch (noncutting) bottom band, for when a breast is missing, there is no anchor to hold the bra in place. This keeps the breast form from sliding up when the wearer raises her arm. The bottom band should be worn snugly around the body.

Straps should rest close to the neck. It is important that the straps not grab the tilted shoulder, for the wearer will feel the weight of her breast form. Rigid straps on the shoulder, with elastic down the back, help prevent bra bounce. Adjust the straps to hold the breast form close to the body.

The strap buckles are in the back of the bra because of the possibility of the buckles causing irritation to the chest wall. With the various levels of surgery on the chest wall, it is important to have a smooth, risk-free front. With lymph nodes removed, any irritation to the surgery side of the body could result in slower healing.

Bras can have features for healthy, comfortable wearing, yet also be beautiful and feminine—enhancing self esteem.

For fitter and customer assurance, you may wish to:

1. Measure from center of breastbone to outside seam across nipple area on both sides. This measurement should be the same on both sides.
2. Measure from midpoint at base of neck down to nipple on both sides. Then measure from nipple to nipple. These measurements should be the same. Adjust the straps to achieve a perfect triangle.

Louise Rose

The after-breast-surgery market is driven by the increased number of surgeries being done each year—whether they are lumpectomies, partials, or full breast removals. If you treat a woman well, she will be with you the rest of her life buying surgical bras and breast forms (silicone breast forms every 2 years or foam forms every 6 months). Medicare pays 80% of the allowable and many private insurers follow this formula. Work with your manufacturer for a sensible stock position. Remember that many will drop ship for you.

Be on the American Cancer Society Reach to Recovery referral list. Detail your surgeons; send flyers home with your customers' statements each month (everyone knows someone). Make your fitter in charge of growing this business. She can speak to support groups and clubs.

There are lots of women in small towns (45 to 50 miles away) who cannot easily get into large cities. Advertise in their local newspaper and capture this market. Plan a fit day in a local motel and be creative.

Louise Rose is vice president of Jodee Inc, Hollywood, Fla. She can be reached via e-mail: .