For many women, a prosthesis fitting begins with retelling their own, intimate breast cancer story.
“There's no rushing,” Kelly Graham said. “There's a lot of crying, hugging and laughing. Every woman's story is different.”
Graham, one of the few fitters remaining regionally, has been a sounding board for cancer survivors for 17 years in her role at Evans City Pharmacy.
Last year alone, she met with 325 ladies.
“For her to be in this field is a blessing,” said Pam Kradel of East Butler, who first visited Graham five years ago following her mastectomy. “She makes you comfortable during a very vulnerable part of your life.”
A career of service
Graham, who'd invested her education and training into a psychology career, first worked with victims of violent crimes, like rape and assault.
That desire to help others led her to enjoy an eight-year job as a counselor and unit supervisor at MHY Family Services.
But things changed in 2000, when the first of her two children was born.
“It became difficult to give as much care to the children at the facility as my little one,” she said.
She switched careers, replacing the pharmacy's former fitter in 2002.
“This was perfect because it is still helping people on a different level,” Graham said. “They're not victims of violent crime, but these women have been traumatized in a different capacity.”
The perfect fit
Graham fits women in a private room in the back of the pharmacy.
Inside, there are boxes with different sizes and some choices in prosthesis as well as racks of bras and bathing suits designed to hold the prosthesis.
After women have been given a chance to settle in, Graham fits them for the bra first.
The bras have pockets to hold the prosthesis “for the security that it won't slip out,” Graham explained.
Women are encouraged to try on items and be assured of size, style and comfort before making a purchase.
Most insurances pay for one prosthesis or one set every two years, Graham said, so it's important to commit to the right one. Out of pocket, the prosthesis can cost between $260 and $320 a side.
“(The prosthesis) is the piece of the puzzle we have to be sure about,” Graham said. “You need to be happy with it because you keep it for years.”
It's also important, Graham stresses, to wait at least four to six weeks after surgery and all fluid drains have been removed and swelling has subsided.
There are temporary garments that can be worn if special events arise in the meantime.
“After 17 years of doing this I can't be pushed,” Graham said. “If you're fitted before the swelling goes down, you could look lopsided.”
Graham also recommends women, before surgery, get a special camisole that holds the fluid drains and bulbs. The camisoles are soft and stretchy and can hold “puffs” for body shape if needed.
“They give you a little shape and a little peace,” Graham said.
She also tells women not to purchase their maximum allowed bras on the first visit.
“Take baby steps ... try one. Make sure you like it,” Graham said. “Ideally, when a woman comes in, my goal is for her to walk out the door with her prosthesis and one bra ... I get super picky in the selection.
“I try to show them the plus and minus of everything they pick. It doesn't matter to me how long their appointment takes. It needs to be right.”
Over the years, Graham said, the prosthesis offerings have changed a lot, in part because medicine has changed a lot.
“In 2002, almost everyone was a single mastectomy,” Graham said.
The available prosthesis was natural looking “but heavy and hot, sometimes pulling away from the chest wall or drooping.”
Nowadays, they're made from a whipped gel silicone that is lighter — but still heavy.
“If they were too light, like the temporary puffs, they'd lift every time you run or raise your arms,” Graham said. “And if you had a double mastectomy, the whole garment could fly up.”
One reason the prosthesis has become lighter is more women today get double mastectomies, as insurances are more willing to pay in cases where women have high chances of a second round of cancer.
“From June to December, I had 35 doubles,” Graham said. “In 2002, I had two all year.”
Another huge change in the industry is a mandate by most insurance companies that a fitter be certified.
Graham is certified with the Board of Certifiers, and receives ongoing education. But many other outlets that once offered this service couldn't keep up the process, she said.
“Kelly is very careful to make sure all your paperwork is done properly so insurance will cover this,” said Cheryl Schaefer of Butler.
Schaefer, a breast cancer survivor who has led the Butler Breast and Woman's Cancer Support Group since 2001, has been familiar with the process since her mother underwent breast cancer surgery 40 years ago.
“When my mom first got prosthesis, they were heavy, like having a bowling ball in your hand,” said Schaefer, who underwent surgery and received her first prosthesis in 2000. Her remaining breast was removed years later.
“My first ones were so hot I used to throw them in the refrigerator downstairs. Now you can get micro beads and they are like air,” Schaefer said.
Schaefer said, unlike herself, many women don't know what to expect. They can be scared and already have been publicly scrutinized by the time they are healed enough to be fitted.
“Kelly puts them at ease. She has the patience of Job,” Schaefer said. “Really, your arms don't even work right at that point. She's kind. She helps in so many ways and doesn't make you self-conscious about it.”
Graham said that is the best part of her job.
“It's not unusual for women to walk in here with their heads slumped, feeling scared and conscious that people in church or the grocery store have stared at them,” Graham said. “But when it's all said and done and you can't tell the left from the right, there's happy tears.”
Graham said she just recently received the biggest endorsement from an unexpected source: a husband.
“Last summer a woman came in very quiet and reserved. She brought her husband for support. That's not uncommon,” Graham said. “The husband waited outside and cracked jokes to make her feel at ease.”
At the end, she threw back her shoulders, walked out and said to him, “Which one was it?”
The husband, in that moment, couldn't answer.
“Now that's a compliment to me,” Graham said.