Door to Opportunity

• By James D. McIntosh, Thomas Schoendorf
• May 01, 2002

Up until the mid-eighties, mastectomy was unquestionably accepted as the gold standard of treatment for breast cancers no matter the stage or size. Studies began to question the notion that only removal of the breast would ensure the greatest chance of survival and decrease the chance of recurrence. It now is generally accepted that lumpectomy with radiation treatment offers much the same survival rate as a mastectomy with only a slight increase in the rate of recurrence. While this has been a wonderful advance for women dealing with breast cancer, the decline in sales in the external breast prosthesis market has some retailers uncertain about the future of their business.

Types of Partial Mastectomies

Most people are familiar with the term lumpectomy, but not everyone recognizes that there are many types of breast conserving surgeries or partial mastectomies. The size, location and type of tumor will dictate how much tissue should be removed. The types of partial mastectomies, in turn, are named to reflect the degree of tissue removed:

Lumpectomy refers to the removal of the tumor and a small amount of surrounding tissue.

Segmentectomy refers to removal of the tumor along with a segment of the breast tissue.

Quadrantectomy refers to the breast divided into four quarters with one whole quarter removed with the tumor.

There are other terms such as tylectomy, open or local excision or wide excision. All of these terms refer to removal of the tumor and some amount of breast tissue, while leaving most of the breast tissue intact. The primary goal for these surgeries is to obtain cancer-free margins while removing as little of the breast tissue as possible. The cosmetic effect of the surgery is taken into account, but it is secondary to ensuring the survival of the patient.

Many women are not aware that products exist for women who have experienced breast conserving surgery.

The Radiation Factor

For a partial mastectomy to be as effective as a mastectomy, it must be followed by radiation therapy. Thankfully, most women will only have temporary localized reactions such as a sunburned-like appearance to the skin that heals as the treatment concludes. Some women, however, experience long-term effects of radiation that include scarring and shrinking of the breast tissue. This effect contributes to the asymmetry that can occur following partial mastectomy. These effects tend to cause permanent changes.

Impact of the Partial Mastectomy

Depending on the location and extent of tissue removed from the breast, a woman may experience small or great asymmetry of her breasts. Frequently, the defect is too small to require a full-sized breast prosthesis. Partial breast prostheses are available to provide a small amount of fullness where the defect is most noticeable. Many women are not aware that products exist to help women who have experienced breast-conserving surgery. Some of these women would not shop where post-mastectomy products are sold because they still have their breast. This untapped market can help the post-mastectomy product dealer branch out and increase sales. The mission must be to educate these consumers so they do not have to settle for stuffing their bras with fluff or going without and hoping no one notices.

Don't Forget Consumers with Breast Reconstruction

The number of breast reconstruction surgeries following mastectomy is at an all time high. Many believe that reconstructive surgery is a simple one-time fix. While there are many women who have beautiful results from their breast reconstruction, there are a great many whose breasts are still slightly to severely asymmetrical. Women who gain weight after their surgery will find that the reconstructed breast will not gain in size like the natural breast. Some will experience a difference of one or more cup sizes. Prosthetic shells can restore a normal looking silhouette. If the difference is severe enough, a regular prosthesis may be necessary.

Where to Start the Education Process

In an ideal world, all women facing breast cancer surgery would have a pre-op consult with a certified mastectomy fitter. Options for regaining symmetry could be given in a positive, supportive environment. This could open up the opportunity for women to ask their surgeons about what to expect. Most health care providers are very diligent about pre-op teaching; however all patients probably do not receive the same information. The truth of the matter is that nurses and physicians receive little to no information about prosthetics in their education curricula. Frequently, they learn about prosthetics from their patients or from vendors.

In an ideal world, all women going for breast cancer surgery would have a pre-op consult with a certified mastectomy fitter..

In recent focus groups comprised of women who had breast-conserving surgery or breast-reconstructive surgery held by a manufacturer of post mastectomy products, 100 percent of the reconstruction patients and 83 percent of the breast-conserving surgery patients verbalized feelings that their breasts were asymmetric following surgery. One hundred percent of the women said they had expected their doctor, nurse or other health professional to educate them on what to expect following surgery, and 100 percent of the women said they did not receive adequate instruction on post-surgical products.

Retailers should try to educate and build rapport with the health care providers in their area. Showing examples of products for women undergoing mastectomy, as well as those who have partial mastectomies, is a good way to let the practitioners see what is available. Don't overlook radiation technicians as one of the front line health care providers. Ask to provide local mammogram centers with product brochures. Women's health fairs and support groups also are good places to educate consumers.

Other Opportunities for Partial Prosthetics

Not all women experiencing asymmetry of their breasts have breast cancer. There are congenital syndromes such as Poland's Syndrome that can cause the breast tissue to be absent or to develop at different rates. Some young women have idiopathic, or no particular cause, for the asymmetric growth. These consumers are usually first identified by pediatricians. Open the door to this information by introducing product or product brochures to the pediatrician and adolescent medicine practitioners. Leave a brochure at the local health club or high school physical education bulletin board. Partial prosthetic shells can help many of these girls and women have a symmetrical silhouette.

What to Expect From the Manufacturers

Manufacturers of post-mastectomy products are using the latest in silicone and textile technology to create new product lines that will be geared toward the partial mastectomy market. The greatest factor to overcome is the individuality of the consumer. While the majority of breast tumors are located in the upper outer quadrant of the breast, two others may be in other locations, even behind the nipple. Consumers can expect innovative products that can accommodate defects in several locations as well as products that look more mainstream and less like mastectomy products. The message will be health and beauty. To stay informed, visit Web sites such as www.TheBreastCareSite.com that focus on educating health care professionals and breast cancer survivors and will showcase the latest products available for this changing market.

This article originally appeared in the May 2002 issue of HME Business.