The Breast Prosthesis Subsidy
(This article was prepared with information from the Ministry of Health website, current as of October 2009) 

A diagnosis of breast cancer will require some surgery. This may be a partial mastectomy (lumpectomy) or a full mastectomy (removal of one (unilateral) or both (bilateral) breasts).

Some women may choose to have reconstructive surgery performed at the same time. Others may decide to delay reconstruction until later on and many will not have reconstructive surgery at all. In these cases, women may wish to obtain a breast prosthesis.

The New Zealand Government (through a division of the Ministry of Health called 'Sector Services') provides a subsidy to help with the purchase of a breast prosthesis and other related products following surgery for breast cancer. Here we offer some information on how to access this entitlement.

If you would like to talk to someone who has accessed the subsidy (and wears a prosthesis), please call us on 0800 BreaCanSupport (0800 273 222) and we’ll talk you through it.

What is a breast prosthesis?
Where can I obtain information about the breast prosthesis subsidy?
Am I eligible for the subsidy?
What products can I claim?
How much is the payment, do I have to pay anything and what time period does it cover?
How do I get my prosthesis?
How do I claim my payment and do I have to pay anything?
How do I find a stockist?


What is a breast prosthesis?
A breast prosthesis (for mastectomy) or breast form (for lumpectomy) can create the appearance of a natural breast. The prosthesis is made from silicone-based material, resembles the shape and weight of a natural breast and fits into a special bra or swimsuit (many suppliers can modify existing bras and swimwear to accommodate a prosthesis).

Most prostheses can be worn in water (salt or chlorinated), require simple care, are comfortable to wear and look very natural. Wearing a prosthesis aids balance and posture and can help women feel more confident about their appearance.


Where can I obtain information about the breast prosthesis subsidy?
The Ministry of Health issues a blue and white leaflet about the subsidy and how to claim it. This should be given to you by your specialist or Breast Nurse before you leave hospital. These leaflets are also available at the Cancer Society and public hospitals.

If you have not received this information:
1. request it from your Breast Nurse or specialist

2. visit the Ministry of Health website for Breast Prosthesis payments

3. telephone Sector Services information on 0800 458 448, Monday-Friday 8am – 5pm (on Wednesdays the hours are 930am – 5pm).

4. Call us on 0800BreaCanSupport (0800 273 222) and we can help.


Am I eligible for the subsidy?
The payment is available to women who:
1. are New Zealand citizens or normally resident here

2. have a current medical certificate from their specialist/surgeon or GP including NHI number and an explanation of why they need a breast prosthesis or prostheses (the certificate is needed for the first claim and not required for future claims)

3. have undergone a partial or full mastectomy, either unilateral (one breast) or bilateral (both breasts),

4. and/or have undergone a lumpectomy,

5. have had failed reconstructive surgery, as specified by a specialist or general practitioner (GP).


What products can I claim?
The payments can be used to purchase a Breast Prosthesis or Prostheses and other related products. These products are:
1. Breast Prosthesis or breast forms (these may include standard breast forms, swim form, foam filler, shell prosthesis and lumpectomy shells)

2. special bras to hold the Breast Prosthesis or breast forms

3. surgical bras and normal bras

4. modifications to bras to hold a prosthesis or breast form

5. prosthetic nipples.


How much is the payment, do I have to pay anything and what time period does it cover?
The amount of the subsidy is $600 (GST inclusive) per breast for a four-year period.

You may claim any amount up to the total amount of $600 (or $1200 for bilateral) at any time during the four-year entitlement period. If you purchase items that cost more than your entitlement balance, then you must make up the difference e.g. if your total purchases amount to $695, the cost to you will be $95.

Note: The entitlement period begins on the date you make your first purchase from a supplier and ends four years from this date. At the end of your entitlement period any unspent amount will be cancelled and another four-year entitlement of $600 or $1200 will be credited.


How do I get my prosthesis?
1. Read the information provided (the leaflet, on the website, or telephone for assistance)

2. Be sure your specialist or GP gives you a medical certificate which lists your NHI number and the reason you require the breast products (the certificate is needed only for the initial claim; not required for future claims)

3. Choose a supplier (your Breast Nurse or specialist should be able to give you details of suppliers in your area), make an appointment for a fitting and take your medical certificate with you

4. Choose the products that are right for you – trained specialist fitters will ensure you are well looked after

5. Ask the supplier to file the claim paperwork for you (this saves you having to do any paperwork!) or you can make the claim yourself.


How do I claim my payment?
Sector Services, on behalf of the Ministry of Health, will make the payment to either the supplier of the product (e.g. Anita BreastCare, NaturalWear) or to the claimant (you – if you choose to file the claim yourself. Most women ask the supplier to file for them).

Claim by supplier
The supplier enters details of the product and its cost on the Breast Prosthesis Claim Form and then asks you to fill in your personal details and sign the form. The supplier will then complete an additional form (stating that they are claiming on your behalf) and will send both forms to Sector Services with your medical certificate (where this is your first claim). You do not pay for the product yourself but keep a copy of the receipt the supplier gives you for your records.

Claim by you
You pay for the product yourself and then file a claim for reimbursement. To make your own claim, first obtain a Sector Services payee number. Ring Sector Services on 0800 458 448 for a Payee Number Application Form and a Breast Prosthesis Claim Form. You will need to complete the forms and return them to Sector Services for reimbursement of your costs.

Claims will not be paid unless the following items are received: a completed Claim Form, a receipt from the supplier and a current medical certificate (for initial claims only). Post the items to:
Breast Prosthesis Subsidy
Sector Services
PO Box 1043
Wellington 6140

How do I find a stockist?
There are two main suppliers of breast prostheses and products – NaturalWear and Breast Care Products NZ (formerly Anita BreastCare). Independent stockists throughout New Zealand will have their products and others on hand for you to try.

To locate a Breast Care Products product stockist in your area, call (09) 421 9281, 0800 264 822, or email nicola@breastcareproducts.co.nz.

To locate a NaturalWear product stockist in your area, call NaturalWear in Auckland on 09 624 3718 or make an email enquiry through their website.

More questions or concerns? Please call us on 0800BreaCanSupport (0800 273 222) and we can help.

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