1. Why is understanding breast structure and motion important?
Despite limited scientific literature documenting breast anatomical structure, understanding the structure and motion of the female breast is a necessary thing to help us better treat and manage breast applications. This includes designing effective bras that provide suitable support and comfort, particularly for people recovering from breast cancer surgeries and for those women wanting to engage in physical activities to aid and enhance their recovery from cancer treatments. An important aspect of breast cancer survivorship is finding comfortable undergarments that work for women's post-treatment bodies. Patients who undergo mastectomy, including both those who do and do not receive reconstruction, need bras that can accommodate new breast shape, size, and feel, as well as scarring and skin sensitivity.
2. How does discomfort from bras affect physical activity in breast cancer survivors?
A study by Gho et al (2010) clearly established that bra discomfort, particularly bra band tightness, is a barrier to participating in physical activity for women living with a breast cancer diagnosis. To further encourage exercise in women living with a diagnosis of breast cancer, potential barriers to exercise, such as inadequate bra design, need to be modified to enable these women to enjoy the health benefits of exercising in comfort.
Nicklaus et al (2020) showed that the breast was the fourth greatest barrier to physical activity in women, behind energy/motivation (1st), time constraints (2nd), and health (3rd), despite its omission from previous physical activity literature. As 33 % of women were not meeting physical activity guidelines, increasing breast health knowledge may reduce barriers to physical activity. . Breast health knowledge increased the use of a sports bra and levels of physical activity.
The following figure taken from McGhee and Steele (2020) shows the main structural components of the female breast including the external skin and the internal fibro-adipose and fibro -glandular tissue which is anchored to the chest wall by a complex array of muscles including the pectoralis major and minor, serratus anterior and rectus Abdominus, adipose tissue, fascia and suspensory ligaments.
A: illustration of a sagittal slice of the breast in line with the nipple. B: sagittal slice of an embalmed cadaveric breast in line with the nipple. The fibro-adipose tissue pockets are highlighted with dressmaker’s pins. *Cooper’s ligaments, walls of the anterior and posterior pockets.
McGee and Steele (2020) have recommended that the mechanical properties of the adipose tissue and suspensory ligaments should be further studied to help understand the breast motion during physical activity and hence help develop garments that provide appropriate support for the breast during activity. Breast composition and density change throughout a women’s life. Size, age, hormonal status and race as well as breast pathologies all impact on the breast tissue composition and breast movement properties.
3. What are the effects of breast surgery on a woman's posture and musculoskeletal mechanics?
Lopera et al (2019) studied the effect of breast surgery (lumpectomy or mastectomy) on the posture and musculoskeletal mechanics of women following surgery for breast cancer. The major problem in women after mastectomy, besides upper limb dysfunction, are disorders in the trunk area, especially the thoracic kyphosis, which has an influence on the formation of functional disorders in the median part of the spine. Women after mastectomy displayed several postural and biomechanical alterations such as altered patterns of scapular rotation in all planes of movement compared with controls. In particular, the scapula on the mastectomy side rotated upward to a greater extent than that on the non-mastectomy side, resulting in scapular excursion. The asymmetry of both soft tissue motility and mass distribution across the chest wall that arises from the loss of a breast, potentially could affect upper limb movements and contribute to trunk or arm symptoms and even limited balance responses. Previous research has already identified that there can be changes in the size and activation of muscles around the upper trunk consequential to surgery for breast cancer, and soft tissue contracture may result from protective posture and movement. These effects may also be due to the reflexive pain-avoiding alignment of the limb. The protective/guarded posture often seen postop of flexed thoracic spine, shoulder elevation and hitching, scapular protraction and spinal lateral flexion towards the operated side can lead to soft tissue fascial and muscular contracture plus contribute to the fear of movement and heightened pain sensitivity of the nervous system. Muscles implicated in this scenario include pectoralis major and minor, serratus anterior, the abdominals, hip flexors and erector spinae. The psychological implications of breast guarding or protection are also a contributing factor.
4. How can breast support garments aid in post-surgery recovery?
The effect of a more appropriate breast support garment following breast surgery in reducing this biomechanical dysfunction is quite significant in terms of correcting posture, facilitating lymphatic drainage of the breast and upper limb, providing pain relief and so encouraging greater pain free active movement of the upper body including the shoulder and therefore ultimately enhancing wellbeing and physical function. The simple action of lifting the breast upward and maintaining that position encourages thoracic extension, shoulder relaxation/depression and scapular retraction along with reduction of breast/chest/arm/spinal pain and ache. Improved posture may also facilitate improved self-esteem and body image.
5. What's the general opinion of women regarding post-surgery advice on bra selection?
McGee and Steele (2023) studied a cohort of 496 Australian women who had undergone breast surgery for breast cancer and asked them their thoughts regarding the level of education, support and advice on bra selection given following their surgery. Disappointingly only 33% of respondents reported satisfaction with the level of support received and 31% reported receiving no advice whatsoever. As it has been reported earlier, the inability to find a well supporting bra was one of the major reasons given by post-surgery breast cancer survivors for not participating in regular physical activity. Cancer rehab physiotherapists know only too well the importance of participation in regular physical activity to assist these women back into enjoying life and providing hope for recovery and wellbeing. Physiotherapists working with these women in helping them recover from treatment side effects are in a great position to be able to offer advice, education and support for women looking for a suitably comfortable, efficient and supportive bra.
6. What are the recommendations for a well-fitting bra following breast cancer surgery?
McGee and Lee (2023) have outlined a number of specific points for a well-fitting bra following breast cancer surgery.
7. Are there any resources available to assist women in selecting a suitable bra after surgery?
Breast Research Australia ((2008) in conjunction with the Australian Institute of Sport has developed a number of client education and support resources to help women with their selection of a suitably comfortable and supportive bra; particularly for participating in physical activity. Advice is given on correct bra measurements, particular features to look for in a bra, and how particular problems with fit and comfort may be resolved. For women recovering from breast cancer surgery and other adjuvant therapies who are experiencing side effects of lymphoedema and lymphatic cording, stiff and/or painful shoulder, scar irritations, spinal pain, and neuropathic pain; specific solutions are offered. This information can be freely accessed through the website www.bra.edu.au
Breast Research Australia: (2008): Sports Bra Fitness
Gho, S., Munro, B., Jones, S., Steele, J.(2010) Exercise bra discomfort is associated with insufficient exercise levels among Australian women treated for breast cancer. Support Care Cancer, 22(3), 721-729
Lopera (2019: )1st International Congress of Science, Technology and Management Journal of Physics: Body posture and biomechanics in women after mastectomy
McGhee and Lee (2023): APA Webinar; Breast Cancer Bra Solutions
McGhee, DE & Steele, JR.(2023). Do the adverse physical effects of breast cancer surgery affect participation in physical activity and sport? Journal of Science and Medicine in Sport.
McGee, D. and Steele, J. (2020): Breast Biomechanics: what do we really know? Physiology, 35(2); 144-156
Niklaus, K., Bravo, B., Liu, C., Chopra, D., Reece, G., Hanson, S., Markey, M.(2020): Undergarment needs after breast cancer surgery: a key survivorship consideration. Support Care Cancer
ABOUT THE AUTHOR
Karen is a physiotherapist in Hahndorf South Australia and have worked for many years in musculoskeletal, womens health and rehabilitation.