Senate Bill S. 3255 has been introduced to provide Medicare coverage for custom breast replacement prostheses.

Issue…

Breast cancer survivors who do not have surgical breast reconstructive surgery have no option for prosthetic restoration of their lost breast. Provision of a choice for custom fabricated breast restoration prostheses will provide women with an less expensive and less invasive alternative to reconstructive surgery at significantly less cost to Medicare.

Medicare provides coverage for a custom fabricated prostheses and restoration of every lost body part EXCEPT the breast - denying women an aesthetically and functionally adequate post-mastectomy option.  The American Society of Breast Surgeons has urged Medicare to provide coverage for custom fabricated breast prostheses.

This is important because…

• The American Cancer Society estimates that more than 192,370 women will be diagnosed with breast cancer in 2009 & a 1 in 8 chance of having invasive breast cancer.
• Breast cancer can leave women with the devastating loss of their breasts and there is no option to obtain Medicare coverage for prosthetic restoration of a women’s lost breast.
• Men are reimbursed for penis pumps, but women are not entitled to prosthetic restoration for their lost breast.

• Reconstructive surgery creates risk and is expensive.
• It discriminates against women – and even more so against older and minority women who are less likely to be able to have breast reconstruction surgery.
• The only current alternatives, silicone bra inserts and special bras that Medicare does reimburse for do not functionally restore the lost breast, and are not less expensive over time than the custom fabricated prostheses.
• Custom fabricated breast prostheses which attach externally to the chest wall that restore functionality are available - the same as custom fabricated prostheses for any other body part at a cost less than most other custom prosthetics.

The solution is:

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