Your Complete Guide to Mastectomy Bra Fitting and Provincial Funding

As Amoena Certified Mastectomy Fitters, our goal is to ensure you feel secure, comfortable, and beautiful after surgery – without the added financial stress. This comprehensive guide covers why a certified fitting is essential and how to access available provincial funding and private insurance coverage across Canada.

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Why a Certified Mastectomy Fitting is Essential

The process of finding the right post-mastectomy garment is highly personal and requires specialized knowledge that extends far beyond standard bra sizing.

What is a Certified Mastectomy Fitter (CMF)?

A Certified Mastectomy Fitter is a trained health professional. They have completed education and practical experience in the proper fitting of external breast prostheses (forms), post-surgical compression wear, and pocketed mastectomy bras.

Our certification means we are trained to assess your unique post-operative needs, including scar tissue and volume needs. This ensures:

• Optimal Comfort: The bra must not irritate sensitive skin or surgical areas.
• Correct Posture: Proper weight balance to prevent back, neck, and shoulder strain.
• A Natural Shape: We help restore balance and confidence under clothing.
• Secure Fit: The pockets securely hold your breast form during activity.

Your Fitting Options

We offer flexible, expert consultation to meet you where you are in your recovery journey:

• Virtual Certified Fitting: A private video consultation with our CMF. We guide you through taking your own measurements and recommend the perfect garments and size. This is perfect for clients across Canada seeking convenience and privacy.
• In-Person Certified Fitting (Barrie, ON): A one-on-one session in our dedicated fitting room. This is the most recommended option for initial breast form fittings, allowing for hands-on adjustments.

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Comprehensive Guide to Provincial Funding and Reimbursement

In Canada, external breast prostheses (forms) are often covered by provincial programs. Mastectomy bras are usually covered by private or extended health insurance.

Important: We will help you complete the required sections of these forms, but final eligibility is determined by the relevant Provincial Program or your Private Insurer.

Provincial Funding for Breast Forms (Prostheses)

The table below provides a summary of the maximum coverage for breast prostheses and the required application forms for major provincial programs. Coverage typically renews every 2 years, unless otherwise noted.

Province/Program	Coverage Details (Max)	Customer Action & Forms/Links
Ontario (ADP)	Grant of up to $195 per side for a full prosthesis.	Form Required: We can provide the ADP "Application for Breast Prosthesis Grant" form during your fitting. You submit the form and receipt for reimbursement. Download the ADP Form 4392-67E
Quebec (RAMQ)	Reimbursement of up to $525 for a full breast form.	Action: You must purchase from a Quebec business and submit the reimbursement application. RAMQ External Breastforms Program Page (Online Application)
British Columbia (PharmaCare)	Coverage of up to $450 for a full breast prosthesis.	Action: Check your Fair PharmaCare deductible status. BC PharmaCare Forms Page (Relevant forms: HLTH 5415/5417)
Nova Scotia (MSI)	Rebate of up to $300 for a prosthesis. Additional income-based funding available.	Form Required: You complete and submit this rebate application with your receipt and physician referral. Download the MSI Rebate Application Form
Manitoba (MBPP)	Coverage for a prosthesis and $70 for one bra.	Action: This is generally administered through CancerCare Manitoba by approved vendors (check for current policies). Manitoba Breast Prosthesis Program Policy Page
Alberta (AADL)	Cost-share program (client pays up to 25%). Coverage for forms and some supplies.	Action: Requires a prescription and assessment by a registered AADL Authorizer. AADL Breast Prostheses Program Page
Other Provinces (SK, NB, NL, PEI, Territories)	Varies (Contact us for details). Limited direct programs for breast forms.	Action: Private insurance is the primary coverage source. Specific low-income assistance may be available.

Funding for Mastectomy Bras and Additional Prosthesis Costs

The cost of your mastectomy bra(s) and any remaining cost of the breast form (beyond the provincial grant) is typically covered by private or extended health insurance. Note that Manitoba is a rare exception with specific bra coverage.

Your 3 Steps to Private Insurance Coverage:

1. Get a Prescription: Request a prescription from your doctor or surgeon. It must clearly state the need for "Mastectomy Bras," "Post-Surgical Compression Bras," or "External Breast Prosthesis."
2. Purchase with Detailed Receipt: Purchase your items from Naturally You. We provide detailed receipts listing the supplier, our CMF details, the product name, and its medical purpose.
3. Submit Your Claim: Send the claim form, your prescription, and your detailed receipt to your private insurance provider for reimbursement.

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Understanding the “Grey Areas” of Coverage

Funding programs and insurance policies are full of fine print. Here are a few common “grey areas” that often cause confusion:

1. How many bras or forms are covered at once?
Most programs and insurers set both a dollar amount and a frequency (for example, an allowance every 12 or 24 months). In practice, that might mean you can get one breast form and several bras at the same time, as long as the total stays within your allowance. Many women choose to use as much of their allowance as possible at once so they have a small “wardrobe” of comfortable options.

2. What if my needs change before I’m due for a replacement?
Weight changes, additional surgery, or natural changes in your shape can all affect your fit. Most programs will not automatically approve an early replacement, but they may consider it if your fitter and physician document a medical or functional reason (for example, shoulder or back pain, or difficulty with balance).

3. Can I combine funding with private insurance?
Often, yes. In many cases you can use your provincial funding first, and then submit any remaining out-of-pocket amount to your private insurer. Every plan is different, so it’s a good idea to check:

• Does your plan cover mastectomy bras and/or external breast forms?
• Is your coverage a set dollar amount or a percentage?
• Do they require you to use provincial funding before they pay anything?

4. Does it matter where I buy my products?
Some programs and insurers require you to purchase from a recognized or accredited mastectomy fitter or boutique. This is to make sure you’re properly fitted and buying medical-grade products, not regular fashion bras. If you’re unsure, ask your fitter to confirm that your purchases qualify.

5. What about tax credits or health spending accounts?
Even when an item isn’t fully covered, it may still be eligible as a medical expense or through a health spending account (HSA). Keep your receipts and any prescription forms. Your accountant or plan administrator can confirm what’s claimable in your situation.

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How to Fill Out Your Claim (Step-by-Step Example)

Every province uses slightly different forms, but most of them ask for the same basic information. Here’s a general walkthrough you can use alongside your province’s form and our Provincial Funding Table above.

1. Patient information
This section usually asks for your name, date of birth, address, and health card or policy number.

Example:
Name: Jane Smith
Health card number: 1234-567-890
Address: 123 Main Street, Barrie, ON

2. Prescribing physician or surgeon
You’ll need the name and contact information of the doctor who is authorizing the products.

Example:
Prescribing physician: Dr. Sarah Thompson
Clinic: Royal Victoria Regional Health Centre
Phone: (705) 000-0000

3. Description of items
This is where you list the products you’re claiming. If you’re working with us in the boutique, we can help you translate product names into something that matches the program requirements.

Example:
Item 1: External breast prosthesis, left side
Item 2: Post-mastectomy pocketed bra
Item 3: Post-mastectomy pocketed bra

4. Quantities and costs
You’ll usually see columns for quantity, unit cost, and total. Many forms also have a separate line for fitting fees if applicable.

Example:
Item 1: Qty 1 × $X = $X
Item 2: Qty 2 × $Y = $2Y
Total cost: $X + $2Y

5. Supplier information
It typically includes:

• Store name
• Address and phone number
• Vendor or license number (if required)
• Signature of the fitter or vendor

We can complete this section for you when you purchase your products and we always provide a detailed, itemized receipt to attach to your claim.

6. Patient declaration and signature
You’ll be asked to confirm that the information is accurate and that you’ve actually received the items listed. Sign and date this section before submitting.

If you’re unsure about any part of the form, bring it to your fitting appointment. We complete claim paperwork like this with clients every day and can walk you through it line by line.

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What If My Claim Is Denied?

A denied claim can feel discouraging, but it doesn’t always mean “no forever.” It usually means the program or insurer needs more information.

1. Read the explanation carefully
Most letters or emails will give a reason, such as:

• Missing prescription
• Item not clearly identified as a post-mastectomy product
• Exceeded maximum amount or time period
• Incomplete form or missing signatures

Highlight the specific reason given. That becomes your checklist for what to fix.

2. Contact the program or insurer directly
Call the number on the letter and ask:

• Exactly what information is missing
• Whether you can resubmit with corrections
• Whether your doctor or fitter needs to provide additional notes

Keep a record of the date, the name of the person you spoke with, and any instructions they gave you.

3. Ask your fitter for supporting documentation
We can often provide:

• A more detailed receipt
• A product description stating that the item is designed for post-mastectomy use
• A letter confirming the fitting and the medical purpose (for example, to restore balance or reduce shoulder and back strain)

4. Involve your physician if needed
Sometimes a short note from your physician explaining why you need a replacement or a particular product type is enough to tip the decision in your favour.

5. Ask about the appeal process
Most programs and insurers have a formal appeal or review process. This may include:

• Filling out a short appeal form
• Providing additional medical information
• Resubmitting your claim within a specific time frame

If you need help organizing your documents or understanding what to include, we’re happy to go through it with you.

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How to Talk to Your Doctor About Prescriptions

Many women feel unsure about “bothering” their doctor for a prescription for bras or breast forms. In reality, a proper prosthesis and bra are part of your ongoing care, not a luxury.

1. Bring your questions in writing
Before your appointment, jot down:

• How your current bra or form feels (pulling, rubbing, slipping, heavy)
• Any pain in your neck, shoulders, back, or chest
• Any difficulty with daily activities (driving, walking, work tasks)

This helps your doctor see the medical impact, not just the cosmetic side.

2. Use clear, simple language
You can say something like:

“I’ve had a mastectomy and I’m experiencing discomfort with my current bra/form. I’d like a prescription for a properly fitted external breast prosthesis and post-mastectomy bras so I can apply for funding.”

3. Ask for the prescription to be specific
Depending on the program or insurer, it may help if the prescription mentions:

• “External breast prosthesis” or “breast form”
• “Post-mastectomy bras” or “pocketed bras”
• The side (left, right, or bilateral)
• Any relevant issues (for example, chronic shoulder or back pain, balance issues)

If you’re not sure what wording is needed, we can provide you with a simple template to bring to your appointment.

4. Mention the funding program or insurer
If you know which program you’re applying to, you can say:

“This prescription will be used for the [Province] funding program and my private insurance, so they may need specific wording.”

5. Book a fitting afterward
Once you have your prescription, you can book a fitting with us. We’ll help you choose products that match what’s written on the prescription and meet the requirements of your funding program or insurer.