BOC-CMF cheat sheet

Fitting is a private, consent-based process: confirm the patient's comfort with a caregiver present, offer a chaperone, and document who was in the room.

Measure at the end of exhalation with the tape level and snug but not compressive; a bust measurement taken over a padded bra or clothing invalidates band and cup sizing.

Standard measurement set: underbust band, full bust at the widest point, and for prostheses, chest wall width (sternum to midaxillary line) and vertical depth (inframammary fold to axilla).

Weight-symmetric prostheses are matched to the remaining breast by base width first, then projection, then volume; width mismatch is the most visible fitting error.

Post-surgical scar tissue, radiation fibrosis, and lymphedema can change fit within months; refit intervals of roughly 6-12 months are typical during the first two years.

Bilateral fittings require symmetric chest wall measurements; asymmetry of 1 cm or more in base width warrants two different prosthesis sizes.

Skin assessment before fitting: erythema, breakdown, or open wounds at the chest wall or shoulder strap line are referral findings, not fitting problems.

Compression garments for lymphedema are prescribed and graded by a clinician; the fitter verifies fit and donning but does not independently change compression class.

Breast lymphatic drainage: most of the gland drains to axillary nodes (pectoral, subscapular, humeral, central, apical), with medial portions draining to parasternal nodes.

Modified radical mastectomy removes breast tissue and axillary lymph nodes but spares the pectoralis major; radical mastectomy removes the pectoral muscles as well.

Sentinel lymph node biopsy removes the first draining node(s); axillary lymph node dissection removes a larger nodal field and carries higher lymphedema risk.

Lymphedema signs: persistent limb swelling, heaviness, tightness of rings or sleeves, and pitting edema; onset may be months to years after surgery.

Nerve injury considerations: intercostobrachial nerve damage causes axillary and medial upper arm numbness; long thoracic nerve injury produces scapular winging.

Post-radiation tissue is less compliant and may retract the chest wall; prosthesis selection favors lower-profile shapes and softer silicone to reduce pressure points.

Breast reconstruction types: implant-based (fixed volume, no prosthesis needed) versus autologous flap (abdominal, back, or thigh tissue) with different contour and sensitivity.

Shoulder range of motion and posture change after mastectomy; strap placement and prosthesis weight should not load the surgical side asymmetrically.

Prosthesis categories: silicone gel (weight closest to tissue), lightweight silicone or foam (for radiation skin, large sizes, or shoulder strain), and partial/shaped shapers for lumpectomy defects.

Silicone gel prostheses are typically sized by base width, projection, and weight in grams; a full prosthesis commonly weighs in the range of roughly 200-800 g depending on size.

Attachable prostheses use adhesive backing or a strap; they stay in place against the chest wall and suit active patients or clothing with less structure.

Post-mastectomy bras require a pocket to hold the prosthesis, a wide band for weight distribution, and straps that do not dig into the axilla or scar line.

Cup sizing: band size is the underbust measurement rounded to the nearest even inch; cup is the difference between bust and band (1 in = A, 2 in = B, 3 in = C, 4 in = D).

Sister sizing: increasing band size by one and decreasing cup by one letter preserves approximate cup volume (e.g., 36C approximates 38B).

Partial prostheses (shapers) are weighted and shaped to fill a lumpectomy defect; they are matched to the remaining breast contour rather than to a full cup volume.

Care rules: silicone prostheses are hand-washed with mild soap, dried fully, and stored in a shaped cradle; adhesives are replaced per manufacturer interval.

Medicare covers external breast prostheses and post-mastectomy bras under the prosthetic device benefit; a physician order and a mastectomy diagnosis are required.

Typical Medicare replacement frequency: one external breast prosthesis per side every 24 months and up to three post-mastectomy bras every 6 months, subject to current local coverage determinations.

Documentation elements: date of service, ordering physician and order date, surgery type and date, side(s), measurements, product description with HCPCS code, and patient education given.

Common HCPCS codes: L8000 (breast prosthesis, mastectomy bra), L8010 (prosthesis, mastectomy, following mastectomy with integrated support), L8020 (partial prosthesis), L8030 (silicone prosthesis), L8032 (nipple prosthesis).

Billing integrity requires that delivered items match the order and the chart; changes in size or product require a new order when the code changes.

Scope of practice: fitters measure, select, and fit; they do not diagnose, prescribe compression class, or manage wounds, and refer those questions to the clinician.

Privacy and consent: fittings occur in a private space, the patient may decline observers, and protected health information is shared only for treatment, payment, or operations.

Adverse events and complaints (skin injury, product failure, allergic reaction to adhesive) are documented and reported per facility policy and manufacturer instructions.