BLOOMINGTON - Ruth Ann Hieronymus is direct when describing the impact of her breast prosthesis.

"It helps me to feel more like a woman," said the 73-year-old, two-time breast cancer survivor.

After losing much of her left breast in a modified mastectomy in 1992, Hieronymus was reluctant to get up in front of people again.

"Going through breast cancer shatters your self-image," said the Atlanta woman. "It (the breast prosthesis) helps to re-

establish yourself and your body image."

Breast cancer and its treatment can be rough on a woman's appearance. Some women lose all or part of their breast, their hair may drop out because of cancer treatment, and their energy wanes.

"Breast cancer affects a woman's body image and self-esteem in the form of breast surgery and possible side effects from treatment such as hair loss," said Jolene Clifford, breast health navigator at the Community Cancer Center in Normal. "The support services that we offer in the community - such as prosthesis, wigs, hats and turbans - allow a woman to restore a positive body image, thus improving self-esteem, which is an important part of recovery from breast cancer."

Clifford discussed the appearance side of breast cancer in conjunction with Breast Cancer Awareness Month, which begins today. Services include a wig bank at Fox & Hounds Hair Studio and Day Spa, the Look Good Feel Better program at the cancer center, and breast prostheses for women who experience a mastectomy or a lumpectomy.

Janet Peters calls breast prosthesis services "non-surgical image reconstruction."

Peters is a certified American Board of Orthotics and Prosthetics fitter with Peters Orthopedics in Bloomington. Peters Orthopedics has been providing orthotic and prosthetic services in Bloomington-Normal since 1995 and expanded into breast prosthesis services in 2004.

"I think the community is really growing in team support" for women with breast cancer, Peters said. She considers Peters Orthopedics part of that team.

Clifford agreed. As breast health navigator with 10 years of experience as a radiation oncology nurse, she assists cancer patients throughout their cancer treatment.

Clifford said she has received positive feedback from patients who have gone to Peters Orthopedics because of the service they've received. Clifford also appreciates that Peters maintains a prosthesis bank for women who don't have insurance coverage and can't afford a prosthesis.

Fewer women with breast cancer are losing their entire breast thanks to early detection and advances in treatment. But mastectomy and lumpectomy - in which a portion of the breast is removed - are still necessary and performed.

Some women opt for breast reconstruction after breast removal. But others don't want reconstruction or don't want it immediately.

Breast prosthesis may be part of the solution for women who don't want reconstruction or can be "a bridge between mastectomy and reconstruction" for women who delay reconstruction, Peters said.

"We call it non-surgical, external reconstruction," Peters said. "And because surgical reconstruction is a process, we can help them with that transition."

"We can't reproduce the natural breast," Peters admitted. But the goal of breast prosthesis goes beyond external appearance and preserving self-image.

Breast prosthesis also serves a physiological purpose by restoring body balance. Peters said losing a breast and not opting for reconstruction or prosthesis may lead to spinal curvature, shoulder drop and neck and back pain.

When a woman comes in for her first fitting varies, Peters said.

Sometime after surgery, the first prosthesis generally is a non-weighted foam piece - about the size of a computer mouse - that fits into the pocket of a form-fitting mastectomy bra, a fashion mastectomy bra or camisole. The light weight is easier for women to tolerate after surgery, Peters said.

As healing continues - about three to four weeks after surgery - a weighted foam prosthesis may be worn in the bra pocket in place of the non-weighted foam piece, Peters said.

Another prosthesis option is made of fiber.

"We're looking for one that gives you the best fit, the best look and the most satisfaction," Peters said. "You build a wardrobe of garments."

About two months after surgery, many women add a silicone prosthesis, which is heavier and looks and feels like a natural breast, Peters said. A ready-to-wear silicone prosthesis may be worn in a mastectomy bra.

Women who opt for a custom silicone prosthesis made from a plaster cast of the patient's chest have to wait about a year after surgery for the site to heal, Peters said.

"It is made to fit the surgery site like a puzzle," she said. Patients may choose the size, nipple size and color of a custom silicone prosthesis. It is held in place by a bra.

Some women who experience lumpectomies choose a shell prosthesis, which fits over the breast in the pocket of a mastectomy bra or camisole to disguise the part of the breast that has been removed, Peters said.

A ready-to-fit breast prosthesis costs about $350. A custom silicone prosthesis costs about $3,000, Peters said. Coverage by insurers varies but many provide some reimbursement, she said. BlueCross BlueShield, for example, provides good coverage. Medicare reimburses up to slightly less than $300, she said.

Peters said she knows what the prostheses mean to breast cancer survivors, even if they don't say anything.

"I see them smile. I see their confidence return."

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Resources

Women dealing with appearance-related side effects of breast cancer and its treatment have several options in Bloomington-Normal. They include:

Breast prostheses, mastectomy bras

Available at Peters Orthopedics, 908 N. Hershey Road, Suite 1, Bloomington, (309) 664-6930; Von Maur in The Shoppes at College Hills, Veterans Parkway and College Avenue, Normal, (309) 454-2048; and Merle Pharmacy, 203 E. Locust St., Bloomington, (309) 828-2242. Medicare and many private insurance plans assist with the cost of breast prostheses and mastectomy bras, but check with your insurer before making a purchase. Peters also maintains a prosthesis bank for women who don't have insurance coverage and can't afford a prosthesis. Donations of items may be made through the Community Cancer Center, 407 E. Vernon Ave., Normal, (309) 451-8500.

Wigs, hats, turbans

Available at Fox & Hounds Hair Studio and Day Spa, 200 W. Monroe St., Bloomington, (309) 829-0482; Hair Club for Men, Women & Kids in the Illinois House, 207 W. Jefferson St., Suite 502, Bloomington, (309) 829-9953; and The Wig Salon in Colonial Plaza, 1500 E. Empire St., Bloomington, (309) 662-4023. Many private insurers will reimburse for hairpieces if your doctor writes a prescription specifying a cranial prosthesis. Medicare does not cover the cost of wigs. Fox & Hounds maintains a wig bank that is primarily for people who can't afford a wig.

Look Good … Feel Better

A free class offered by the Community Cancer Center in partnership with the American Cancer Society and taught by licensed cosmetologists offers beauty techniques to help women cope with side effects associated with cancer treatment. Classes meet at 6 p.m. on the first Monday of each month at the cancer center, 407 E. Vernon Ave., Normal. Register at (309) 451-8500.

SOURCES: Community Cancer Center, Jolene Clifford