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:
http://www.breastcancer.org/tips/lymphedema/risk.jsp
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!
Val
Comments
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Great job Val and Deborah!
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Val and Deborah.........thank you so much!! This is wonderful information. I just got my tattoos a few weeks ago and I'm ready to go bra shopping again. I have one bra that I've been wearing and washing........so I'm ready to go try some of your suggestions. Thanks for taking the time to research and compile all of this.....it is a wealth of info!!
Hugs, Kathy
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This is all from our Bra Whisperer, Val! I just added some bra ideas. I think it is a much needed thread!
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Thank you Val & Deborah! Boy, and here I thought I would never have to wear a bra again. What about those of us who have the Alloderm Sling? Is a bra still necessary with these?
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Thanks so much. Very, very informative. I will look up those bras. As I have used the thought of bralessness as a consolation for this whole sad business of BMX, I am feeling a bit disappointed...BUT what you say about supporting the breast while healing and facilitating well placed scar tissue formation to provide internal structure for the implant certainly makes sense. What are your thoughts about tossing the bras 3 or 4 months post exchange, once well healed? Also, do you think the requirement for a bra and need for support is changed in any way by size ( weight) of implant or type of implant (cohesive like the Allergan 410's or Mentor CPG's vs. saline or conventional silicone)? Or perhaps by contour of the reconstructed breast ( "perky vs. droop)?
Very interested in your thoughts on this.
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Thank you, Val and Deborah, for starting this thread! We brahaholics need some guidance!
I also have to recommend this well made, comfortable bra: Natori Lace Body Double Bra Style 136001. This is a molded bra with comfortable wide lace straps, and I wore it for sleeping for a long while because it felt so good. The cups aren't too deep, which makes it great for me. It is a nice t-shirt or sweater bra, and I wear it most days now. I found it at Nordstrom.
I also love the Pollyanna by Freya, but I can't wear it with close fitting clothes. It provides absolutely perfect support. (Thanks for the recommendation, Val!!)
MBJ, I have an alloderm sling on one side, and my PS told me I have to wear a bra from now on if I want my implants to stay where they are.
Jerusha, I have smaller implants at 400 ccs (silicone), and I must always wear a bra. My PS said I can do what I want at night, but I prefer wearing a bra at all times.
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Valerie & Deborah,
What invaluvable information! It sure makes sense to me that these new breasts need as much support in their proper position as possible while they are getting used to their new home. I actually have to tell you I even feel more comfortable in the underwire as I get used to them. This is such an educational journey from the very beginning.
I also shared the news about proper measuring and fitting with the BFF and my daughter....probably every woman could benefit.
Thank you again for doing this.
Marianne
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Hot off the press from the "Today" show this morning: There was a segment on bras and it was stated that 9 out of 10 women are wearing the wrong size bra. The mantra from a woman called "Linda the Bra Lady"...."DOWN IN THE BACK, UP IN THE CUP."
(Translated: Lower your band size and raise your cup size)
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I had bilateral implants (exchange was in December). Alloderm was used on both sides to enhance the muscle coverage and additional skin thickness. Due to a wide rib cage, I have 800cc implants that give me a full "B" cup.
Other than a compression garment wore for three weeks after the exchange, I was told by my PS that I would never have to wear a bra again unless I wanted to. He assured me that the lack of a bra would in no way deleteriously affect the appearance or placement of the implants.
After three weeks, he also told me to continue with my regular exercise regimen and to especially flex and stretch the chest muscles.
It is coming up to 6 months after my exchange. The implants have dropped and fluffed and assumed a nicely centered position. I also have some movement in that if I lie on my back, the implants will fall somewhat to the side (like a 17 year old's).
I guess the use of a bra may depend on a PS's skill, implant technique (alloderm or not) and the patient's own physical condition. I am almost 60 so I don't know if age is a factor.
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I'm 49 and my PS doesn't require a bra. When I ask her underwire or regular, she responded, it doesn't matter, you never have to wear a bra again if you don't want to. I'm 4 weeks out from the exchange and I'm experiencing the drop and fluff now. They look much better now but still don't have the shape that fills out the point of the bra. One of our local BC survivors told me they never would. She is 5 years out, has large implants, but is still a big round mound. Do the bras listed above help to shape your breast to fill out the tips of the bra?
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Thanks, ladies! We're just trying to share some information for those who want it!
MBJ - I don't have Alloderm, but my ps has the same instructions for his patients who do have it, so I don't think it really is a factor. It does provide some extra stability, though, so that's always a good thing to have!
Jershua - I can't see where implant style would impact the bra issue, really. Size perhaps - if you have VERY small implants (like an A cup) - it might not matter. As for wearing a bra after the initial healing, mine says it's okay occasionally, but not on a regular basis.
Sassa - So glad everything's working out well for you!
Susie123 - Sorry, but your friend is right.....and no bra will reshape your breasts in the front. Reconstructed breasts are just shaped differently than natural breasts because of the loss of the nipple-areola complex. That's what gives natural breasts that slightly conical shape. That being said, the bras that I've listed there DO fit reconstructed breasts well - and I found most of these pre-nipple reconstruction.
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Discount shopper alert!!!! I was at Marshall's today and they had quite a few nice bras for VERY good prices - less than $20 - even for some Natori's. They also had LOTS of inexpensive, larger-sized bras that would work very well after exchange. One was a Lillyette. Check our your local store and you might just find some deals!0
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Val and Deborah:
Wow, you two put a great deal of work into your article and it shows. I am so grateful to have this site and this valuable info. I am living proof that Val knows her stuff.
I just bought the :
Wacoal Awareness Contour Soft Cup Bra
Style 856167 Naturally Nude - 32C1 $52.00 $52.00 Natori Body Doubles Lace Trim Contour Soft Cup Bra
Style 137001 Café - 32C1 $52.00 $52.00 I am very happy with both of them. Val helped me a great deal.
Thank yo!
Kristen
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It seems so odd to me that there are so many different protocols regarding bras, time in them, wireless or not...etc. It often seems that these are not based on the particulars of the individual woman's situation (radiation, tissue integrity, use of muscle flap, use of alloderm,etc), but rather on the individual PS, and what he/she advises in general. How we look and feel after the reconstruction surgery is over seems so vital. The long term outcome is such an integral part of the process. The process doesn't end when we wake up from the exchange, or even have our final post-op visits....WE know that! You would think that the outcomes would be studied and validated and that there would be consensus as to the best post-op and long-term protocols (for the various "types" of patients, rather than idiosyncratic directives based on each doctor's anecdotal experience. Its called Evidence Based Medicine, among other things.0
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Val, this is a great site and thanks to Deborah as well for her valuable input.
Kristen, where did you buy Waacol Awareness for $52.00. I paid more at Nordstrom.
I am having my exchange and a lift in 1 week and had a bil lat dorsi reconstruction. I saw my PS last week and he said I looked great. I told him I have been wearing a bra 24/7 and all he said is "good"
Jerusha, I was thinking along those same lines. I have done medical writing and was searching for a scholarly article regarding the science behind various types of reconstruction procedures and bra recommendations based on something other than a doctor's anectodal experience. It seems that a lot of male plastic surgeons defer to their office nurses (an LPN or MA)for patient's bra recommendations. I want to understand the science behind what is necessary to retain the integrity and protect a patient's reconstruction in order to avoid an unecessary revision.
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Thanks for putting the time in on this Val! Even tho I've been a long time devotee of wireless, I just might go try one of these on! Comfort is my main thing, don't think I could last a day in a tight band and straps.
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Hello everyone,
I sure appreciate this site! I am scheduled for exchange 6/29 so I am getting as much info as possible. My surgeon does not reccommend underwire but I am not convinced because I have an issue with one of my folds being lower than the other. I want to make sure I do everything possible to heal in the right place. How soon did you wear underwire-was it immediately post-op? I'm supposed to be going home in a surgical bra with no underwire. I just feel very overwhelmed with all of the different info. Thanks for your help.Also I measured under my TEs. It is 30 pulled snugley. I'm thinking I will need a 34 band size for good support. What do you think?
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Re measuring our bra size. I measure 33 above the breasts and 36 at my fullest, so that's only three inches yet in many bras I wear 34D. Some 34Ds are too large but most are just fine. Isn't that strange? The owner of a mx speciatly bra shop says that manufacturers vary so much with their sizes, and she says not to get too hung up on the exact size but instead go with how each individual bra fits.
Ruthie, try measuring above your breasts according to STEP 1 above. If you measure 33 or 34, a 34 band size should work for you. I started wearing an underwire at one week. Good luck to you! Don't be overwhelmed! Everything works out in the end.
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Waldo
I ordered the waacol from www.herroom.com
If you ordered two bras you could get free shipping. I did wait a week for them but it was worth it.
Good luck
Kristen
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Ruthy - My ps has you in an underwire as soon as you can get fitted professionally after the drains come out (which he always uses) and he can check the fit. That turns out to be about a week under normal circumstances - just like Kristinka's ps. From the time the foam wrap (which is what he uses at surgery instead of a surgical bra) until then, he puts you in a very soft, unstructured bra that he provides - the Warner's Elements of Bliss lightly lined (no padding) one. You just want to make sure that you get a good fitting, as the wrong size bra could do more harm than good.0
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Barenecessities.com has a sale going on. Some pretty good prices!0
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WOW Val! Great information!
I just had my exchange this Tuesday!! Much, much more comfortable than the bmx. Didn't need any pain meds except Tylenol.
My PS had me purchase a bra(s) before my surgery, he however directed me to Target since he didn't think I needed to spend a lot on a bra. He explained the most important part of the bra at this stage is how the underwire cradles under the breast. We don't want gravity to work too fast. I will be wearing mine 24/7 except at shower time. He mentioned a minimum of 4 weeks, so my guess it just depends on the patient.
So it is very interesting to hear from many different PS sides of view.
Good luck everyone!
-catherine0 -
VAL !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
OMGOSH cutie..... I THOUGHT YOU ALL WERE JOKING ON EC about this thread... ROFLOL !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! I LOVE IT!!!!!
I am off to work Val.. but there is a lonely girl on BCO named MANTRA.... she started a thread called BRA FITTING.... looks like she needs our new .." BRA WHISPERER" to go save her...
Love you!
Off to work...................
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Thanks, Laura Sweetie!!! When I say I'll do something, I'm much too "type A" to not follow through! I'll look into Mantra.....
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Waldo....Wacoal on Ebay....the style number Kristen mentioned. Great prices if you can find your size...
I knew you before I formed you in your mother’s womb. Jeremiah 1:5.
Diagnosis: 10/15/2008, IDC, 1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR+, HER2-0 -
Sorry.....I know..it did not work...Just go to Ebay and type in Wacoal Awareness Contour....
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Thanks Deborah, I am washing bras constantly since I have no clue what size I'll be wearing in 6 days. I am so excited about the exchange. I hope I am happy with the outcome.
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Hi all, The thing about bras that's so uncomfortable to me is that most bands cut in around my ribs after a few minutes and I just can't stand it after a while. Before MX, I alleviated this somewhat when I needed a bra by buying a 36 inst of a 34, which is my official size. Mostly I just didn't wear a bra. I've found that the wider the band on the bottom the less cutting, but mostly I find sports or stretch bras have those bands, not "real" bras that fit Val's description and that are easily worn with regular clothes. Can anyone recommend any bras that seem to be good support bras that are "regular" bras for reconstructed women that have wide bands around the ribs, at least an inch wide?
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Hi cs77....I've been wearing the Warners style # 02019. It is a non underwire contour bra with a little push up cookie built in. The band is fairly wide and I think pretty comfortable.
I'm going to look at the Wacaol bra as soon as I get within spitting distance of a mall. I'm curious as to whether it will improve my look any. I'm pretty flat across the apex of my foobs, especially the old rad side, so I suppose I will have to have a contour bra to prevent wrinkles to the bra fabric. Is this the case with most of us? Just wondering.
Bobbi
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I have a question for you bra wizards. It seems almost everyone is looking for a bra that keeps her breasts from migrating into the armpits. I have the opposite problem. I don't believe I have Symmastia, but my breasts are barely 1 finger's width apart at the sternum. The left side does extend a little bit laterally past my ribcage, but my right side is even with my ribs and needs to be pushed a little farther to the right. I had multiple infections in that area and my PS believes scar tissue is preventing it from dropping (and staying) fully into the pocket. I can push it where it needs to be (and was instructed to do that with massage) but it doesn't stay! I am 5 months post exchange.
I would like to find a bra that offers as much separation at the sternum as possible. Do any of you know of a good bra that does that? I wear thong bra for sleeping but would like to have a bra for daytime wear. All the ones I have tend to "push them together".
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