Bras 101: The Great Post-Exchange Debate
BRAS.......whether you love them or hate them, they are often part of our reconstruction journeys. Whippetmom and I decided to share some information that we discovered throughout our respective journeys through breast reconstruction. There are different practice styles and philosophies among plastic surgeons (PSs), and this extends to their feelings and recommendations about bras after exchange. Some of our PSs have very specific instructions regarding underwire/wireless bras; some say no bra is necessary, and some say nothing on the subject. It seems that a great number of PSs fall in the latter category.
Please note: We are NOT physicians or medically educated....just fellow bc sisters who have researched this subject and want to share what we've learned
If you have lymphedema or have been told you are at risk for it, please discuss the issue of bras and supportive breast wear with your physician. Risk factors:
Why would I need a bra after reconstructrion? To keep those lovely implants where your PS placed them. Because underwire bras provide such excellent implant support and stabilization (when properly fitted), many plastic surgeons advocate the use of them soon after the exchange surgery. The wire provides "encapsulation" to help prevent implant migration. This was my experience. My PS sent me for a professional bra fitting (at Nordstrom) as soon as the drains were removed. I wore that underwire bra 24/7 (I bought two - worn VERY tightly in both band and straps - for the next 3 1/2 months.....yes months! That is the time it generally takes for scar tissue to form the "capsule" around the implant. Until then gravity and arm movements can cause the implants to migrate.
Some have asked if underwire bras could harm the new sutures and pocket work after exchange. While those of you whose incision line is along the IMF (inframammary fold) will likely be unable to wear underwire for awhile, most of us with traditional trans-aerolar incisions will be allowed to wear them. My PS's belief is that an underwire is absolutely necessary to provide adequate support for the implants, as there is little else to support them initially. We need to think about what's supporting our implants. Many of us here have had TE's [tissue expanders], so our implants are essentially held in place by our (often very thin) expanded tissue coupled with the various chest muscles and sutures. (Not the case for those who've had flap procedures.) Eventually (3-4 months according to most PSs) scar tissue forms the capsule, which then adds some additional support. Despite rumors, there is no need to fear about missing the often discussed "drop and fluff" of the implants; wearing a bra will not interefe with that. Even with support from a bra, the implants will settle into the pockets - promise! The degree of "drop and fluff" is greatly influenced by the expansion process (style of TE & fills), so there is a lot of variability among us.
There are some PSs who believe that reconstruction patients need never wear a bra - a topic hotly debated around these forums, for sure. As with much of the reconstruction process, philosophies differ among physicians. There are some PSs (mine included) who feel that reconstructed breasts will ALWAYS need the support of a bra except for short periods. And yes, that includes during sleep - especially in the first several months - perhaps much longer for many of us. Believe it or not, many of us actually discover that it is more uncomfortable to NOT wear a bra . Gravity is not a friend....to faces, fannies, or foobs!
We realize that not every PS or sister with reconstructed breasts is as "pro-bra" as we are. But for those of you who want to maximize your reconstruction results by minimizing implant migration-and have no contraindicating factors- hopefully this information will be useful. Of course, we want to clarify that the quality of the bra is essential. Not all underwire bras are appropriate for the purpose of encapsulating and supporting the implants on the chest wall. A high quality bra, which uses better fabric and wires in the construction, will provide superior fit and longevity while doing its job of providing proper implant support. Many insurance companies offer coverage for even non-surgical bras, so be sure to check.
What about size? A HUGE question! Sizing is a bit tricky with implants because they are wider and flatter than natural breasts. If you don't have access to a well-trained professional bra fitter (Nordstrom fitters are famous, but many other department stores and small boutiques are good, too), then here's a good place to start: http://www.herroom.com/bra-fitting-advice,904,30.html Sizing with implants is very much a trial and error process, but this technique is generally pretty darn close. ***Please note: These are different from the conventional "just measure around your ribs, then your chest" instructions, but I think they result in a truer measure of size for many people. Implants are much wider and flatter than natural breasts, so sizing is a bit iffy, though the technique described at herroom addresses these issues. Just as with clothes, sizing differs between manufacturers, so be prepared to try lots of bras!
What kind of bra do I need and how should it fit? Well, the main goal of the bra post-recon is to stabilize the implants both laterally (from the side) and vertically (from the bottom). Some of us may need a bra that also does not allow the implants to move too much toward the center - the dreaded "uniboob." For most of us, though, the main goal is to find a bra that does NOT push the implants out to the side. I can't stress this enough! This is one of the leading reasons for revisions. This can be very difficult to find, especially in a non-wired bra. Be careful of any trim along the center edge of the cups, as even this can push the implants out. The best type of bra is an UNLINED one - yes, no lining or padding at all - because these can interfere with optimal positioning of the implants. Here's the clincher: ideally the band should be extremely tight and the straps pulled as tightly as possible so there is no "vertical play" in the implants. We Americans are all about comfort, and we wear our bras far looser than our European friends! You should initially be "aware" that you are wearing a bra, which is a nice way of saying its going to be snug .
In fitting an underwire bra, be especially careful that the wire completely encapsulates the implants, especially on the outside. The wires should sit just on the outside edge of the implant (under your arm). In the center, be careful that the wires sit slightly AWAY from your chest and don't touch the implants, which could push them to the outside. If the center wires push into the sternum (a common complaint), the cup is too full. If the wires sit more than about 1/4" away from the sternum, the cup is too small. Our upper-pole fullness depends on our implant style. Some bra brands tend to run fuller in the cup than others. The idea is to keep the implants contained in the proper position on the chest wall, and most importantly, to keep them from migrating laterally or medially on the chest wall. If you engage in high-impact exercise (running, aerobics, etc.) the same instructions apply, plus one more: the implants should be held snuggly against the chest with NO BOUNCE! This may require two sports bras - one for encapsulation and one for compression - but it'll be worth it in the end.
Some of our "Bras 101" favorite brands are:
Freya, Fantasie, Chantelle, Marena, Wacoal, Anita, Goddess, and Soma.
Good luck! And remember - this is just ONE point of view!
Some of our favorite bra websites:
Thanks for stopping by and checking out our thread! Hugs!