Breast Prosthesis / Mastectomy Prosthesis
A breast prosthesis, also called a mastectomy prosthesis, is a covered medical device used to restore body contour after breast surgery. Health plans often reimburse part of the cost of external breast forms, specialized bras, or related supplies when deemed medically necessary by a physician.
How It Works
A breast prosthesis is an external silicone form worn to replace one or more breasts that are totally or partially absent following a mastectomy or lumpectomy. In Canada, several provincial programs, such as Ontario's Assistive Devices Program, Quebec's RAMQ External Breastforms Program, and Nova Scotia's Breast Prosthesis Program, provide financial assistance toward the cost of an external breast prosthesis for residents who have undergone a mastectomy or lumpectomy. Provincial coverage typically distinguishes between a full breastform and a partial breastform, with a separate maximum reimbursement for each type. Under BC PharmaCare, following mastectomy or lumpectomy surgery the program covers breast prostheses along with related items such as lymphedema arm sleeves, and pre-approval is not required for most breast prostheses, though time and quantity limits may apply. Beyond provincial programs, an external breast prosthesis required because of a mastectomy and prescribed by a medical practitioner is an eligible medical expense under the Canada Revenue Agency's Medical Expense Tax Credit, listed under paragraph 5700(j) of the Income Tax Regulations, and because it is eligible it can also be reimbursed through a Health Spending Account or Private Health Services Plan when a valid prescription is held.
Example:
After a single mastectomy, an Ontario resident with a valid health card is prescribed an external silicone breast prosthesis and applies to the Assistive Devices Program for a grant toward its cost. Because income is not considered for this program, she qualifies regardless of her earnings, but the program funds only one prosthesis per side and will not pay to replace it again until her old one is worn out, two years have passed, and it is no longer under warranty. She also keeps her prescription and receipt so she can claim any remaining out-of-pocket cost through her workplace Health Spending Account, since the prosthesis is an eligible medical expense under the CRA's Medical Expense Tax Credit.
What to Watch For:
Replacement of a breast prosthesis is generally funded only once a defined time period has passed, for example after two years, or when a new prosthesis is required due to a change in your body size, shape, or medical condition. Provincial programs generally do not cover the cost to replace a lost prosthesis or to repair a prosthesis damaged through misuse or neglect. Keep in mind that the tax credit applies only to the prosthesis itself. The CRA has ruled that the cost of special undergarments and bathing suits worn to hold a breast prosthesis in place after a mastectomy does not qualify for the Medical Expense Tax Credit, because Regulation 5700(j) prescribes only the external breast prosthesis.
