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Topic: Bras 101: The Great Post-Exchange Debate

Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.

Posted on: May 25, 2010 06:30PM - edited Feb 15, 2013 07:16AM by val61

val61 wrote:

BRAS.......whether you love themKiss or hate themYell, 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 themSmile.  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:  www.herroom.com/bra-fitting-ad...   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:

http://www.herroom.com/

www.barenecessities.com/

www.biggerbras.com

shop.nordstrom.com/ 

www.brasmyth.com

Thanks for stopping by and checking out our thread!  Hugs!

ValCool

bmx w/ TE's 1/21/09; recon completed 7/9/10. "We must see all scars as beauty, okay?...A scar does not form on the dying. A scar means, I SURVIVED!" (excerpted from "Little Bee" by Chris Cleave) Dx 12/19/2008, ILC, <1cm, Stage IB, Grade 2, 0/4 nodes, ER+/PR-, HER2-
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Sep 4, 2020 10:02PM Lostchick wrote:

thank you guys so much! I think I'm going to make an appt for a fitting and some help at a local store near me that specializes in bras etc for those going through treatment. I've been scared to go out much due to Covid but it is so frustrating ordering and sending back pretty much on a daily. Ugh. I actually got another bra today (I feel like I order a new bra everyday!) and it's so comfy! But I'm laying here really inspecting it now and realizing that it's way too big and so therefore probably not doing much in terms of support. That's probably why it feels so great! I have a friend that went through reconstruction 7 years ago and rarely wears a bra ever since her surgery. My doc said my foobs would migrate to my pits without support. :( so I'm super paranoid about that.

Dx 2/20/2020, ILC, Right, ER+ Surgery 5/11/2020 Mastectomy; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Dx 5/12/2020, IDC, Left, <1cm, Stage IA, Grade 2, ER+
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Sep 14, 2020 06:36PM pennythepest wrote:

I had a bilateral mastectomy in 2004 and the implants had to be removed within a few weeks so I've been flat-chested ever since. I have never found a bra that fits since then. I obviously need pockets for my prostheses and have to have a front hook because of my arthritis. I've found numerous bras that look like they would work but when I get them they don't fit. I've also tried every local shop that was supposed to sell mastectomy bras and never got one I could wear. What do you measure when there are no breasts there and how does that work with the bras that appear in catalogs? Even the Breast Cancer catalog didn't have any suggestions. I have B-cup prostheses.

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Sep 14, 2020 08:08PM MinusTwo wrote:

Penny - because I have Lymphadema, I use the Wear Ease Sydney bra. You can step into it or pull it over your head. It does have 'sleeves' for your prostheses. Also it has a deep "V" neck so you can wear it with regular clothes. This is a woman owned company with products made in the USA and they are very good at helping over the phone. It may not be anything you want, but here's a link so you can take a look.

https://www.wearease.com/products/sydney-bra?varia...


2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Sep 14, 2020 09:25PM MinusTwo wrote:

Penny: The other advice that I learned from this thread and followed after my first surgery was go to Nordstroms. They have bra fitters that are trained to handle all kinds of cancer & reconstruction issues. Call ahead and make an appointment to make sure a fitter will be there when you are. Hope you are close enough to a store to give this a try.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Oct 9, 2020 11:00PM - edited Oct 9, 2020 11:05PM by Foxtail

I wandered over to this forum as I current have expanders in and I'm beginning my research on bras to wear -at the end of it all- which is still some time away. In the meantime I thought I'd share the bra that I've been wearing since my BMX that has worked absolute wonders. It's available on Amazon, BRABIC Women's Front Closure Bra Post-Surgery. I haven't been able to find (yet) any other bra that comes close to the coverage and support it provides though I do still want to find other sports bra types depending on whether I will need more or less compression after a swap -with fat graft-. Thank you to the ladies that have mentioned fat grafting affecting what to wear so I know to ask what I'll need beforehand.

There is a size chart on the page. For reference pre-bmx I was a solid 36C and I picked up both a XL and XXL. I'd been advised to size up one post surgery. The XL fits perfectly as the band at the bottom isn't too tight and it's stretches well -while- retaining it's shape. I do not however currently use the breast straps. I left them on (for the next surgery if needed) and just let them hang beneath a shirt, hook beneath or even behind the back. I also love that it fits more like a vest. For refence I'm 5'9" and the thick elastic hem sits roughly a full inch, maybe two beneath my IMF. I've had no issues with it rubbing against my incisions. Also, the straps are thick and they have hooks in them. You can completely remove the bra, for those times you just want to rip it off to be comfortable, by unclasping the shoulders and front. Viola! Just thought I'd extend it to anyone who might be facing surgery or anyone post-inter that might be looking. I've had these for three months and they get washed every few days, no degradation in them yet. Just throwing out a potential.

P.S. This bra was a lifesaver as it also comes high under the arm pits without digging in. It saved me from the awful new experience of hot or weirdly clammy arm skin rubbing and suctioning at the side of my breasts. Took care of that and yes, it breathes well. WOO!

Dx 6/2020, DCIS, Right, Stage 0, Grade 3, 0/5 nodes, ER-/PR- Surgery 7/14/2020 Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 7/14/2020 Mastectomy: Right; Prophylactic mastectomy: Left

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