Tips: Breast and chest wall oedema
Maree O’Connor Lymphoedema Physiotherapist
Wearing the right bra is essential not only for managing breast oedema but also for arm lymphoedema. To delve deeper into this topic, I interviewed Heidi Flaherty, Marketing and Education Manager at Amoena. Amoena has been a market leader in breast care since 1975.
Maree
Wearing a properly fitting bra is crucial for managing breast oedema, but it’s equally important to avoid bra straps digging into the shoulders, especially with arm lymphoedema. What are some key tips to keep in mind when selecting a bra for these conditions?
Heidi
If you have a patient managing lymphoedema symptoms, make sure you talk about their bra to ensure they’re getting the support they need but not negatively impacting on their lymphatic flow.
Some key things to look for in an everyday bra if you’re managing lymphoedema symptoms include:
- A correct fit is crucial to ensure that the bra is supportive, comfortable and not causing disruption to lymphatic flow. We highly recommend getting your bra professionally fitted.
Wider, supportive underbust band. This band needs to support up to 80% of the breast tissue weight. Having a wider band ensures that the weight is spread over a broader area so as not to create any pinch points. - Wider straps. Padding may also be helpful for extra comfort. Straps are to support 20% of the breast tissue weight, so make sure that the strap is wider to spread the load & avoid pinch points.
- Higher coverage, especially across the breast cup, underarm & back. Avoid styles that dig into the skin in key areas like the underarm, especially if they have reduced sensation in the area.
- Minimal or flat seams, avoid bulk & prioritise comfort. Bulky seams may cause irritation & disrupt lymphatic flow.
- If your patient has reduced mobility in her arms & shoulders, a front opening bra may be easier for her to put on.
- Comfortable fabrics to support sensitive skin.
Maree
Can you expand on compression for breast oedema?
Heidi
Lymph Compression bras have been designed to apply targeted pressure over the bra area. Bras with medical grade pressure will need to prove that they have been tested to assess the level of compression. This is typically tested according to RAL-GZ 387. In Australia, medical grade compression garments will also need to have been approved by the Therapeutic Goods of Australia TGA).
Compression bra designs will typically have higher coverage, over the bra cup area, underarms & over the back, this is to ensure that the edges of the garment do not dig into breast tissue or other areas.
In a compression bra, it’s important to look for a fabric with sufficient structure to maintain the level of compression required.
A bonded fabric provides a high level of structure and stiffness. Some bras with bonded fabric may also feature seamless construction, which is beneficial for reducing irritation & disruption to lymphatic flow.
If the compression bra is constructed from a knitted fabric, ensure that the structure of the knit will hold its shape & compression over time. Knitted fabrics mould more closely to the body & allow some give in the bra cup area which may be helpful for larger breasts
Textured surfaces are also beneficial in a compression bra if designed to give the wearer a light massage when moving. These textures may be part of the fabric construction or added on in the form of 3D printing.
Most compression bras will typically be front opening, making it easier to put them on.
If the bra has a zipper opening, look for a small hook or magnet to hold the bra closed whilst connecting the zipper, this will make it easier to put on.
If your patient isn’t a typical bra size, or has fluctuating swelling, look for an opening that allows for adjustment, for example several rows of hooks & eyes. This will allow them to tailor to fit as needed.
Straps that can easily be opened from the front are also helpful, especially if you need to place a compression pad around the shoulder area. Closures like Velcro, hook & loop or hooks & eyes provide support & the ability to adjust the fit if needed.
Compression Testing
- Amoena CuraLymph compression bras have been tested according to RAL-GZ 387 using the HOSYcan compression testing device
- These compression testing was conducted by Hohenstein in Germany
- In addition to measuring compression, this also allows the yarn count & elastic extensibility to be tested.
- When testing a compression garment, up to 20 key measurements are taken on the body & also on the garment to gauge the level of movement that the garment may undergo.
- Then the garment is attached to the HosyCan device at this measurement points & undergoes compression testing, where the clamped points are stretched & data is sent to the computer for analysis.
- From there, the level of compression is then determined.
Maree
What are some tips when fitting compression bras?
Heidi
If your patient hasn’t worn a compression garment before, there are some things to keep in mind when recommending that they wear a compression bra:
- Consistency of wear- they will only get the benefits of the compression if they consistently wear the bra as recommended. It can take time to get used to wearing one, so discuss how they may approach it. For example, wear for 2 hours, then have a 15-minute break from wearing, then put back on for 2 more hours.
- Too much reliance on a compression bra rather than managing lymphoedema holistically. Compression works best when utilised within a holistic approach including manual lymph therapy, prescribed exercises, balanced diet & good skin care. They are also helpful for prolonging the benefits after a therapy session.
- Willingness to try- talk through what might deter them from wearing a compression bra- is it the feel, the style, the cost etc.
If you are not confident or have not been trained to fit a bra, then connect with a local bra fitter who is familiar with fitting bras for lymphoedema. This will allow you to focus on recommending the right level of compression whilst the bra fitter focuses on getting the right fit for your patient.
Tips for bra fitters: remember your good bra fitting habits, especially:
- Ensure all breast tissue is encased comfortably in the bra
- No spillage (especially under the arms)
- No parts of the bra dig into the skin
- The customer feels supported & comfortable in the bra
Compression bras are made to be a firm fit for the patient to get the benefits of compression in managing their lymphoedema symptoms.
The bra will be::
- Supportive & firm
- Snug but not tight or painful
- No parts of the bra should be digging into the body
- Shouldn’t leave any irritated marks on the skin
- Where the 3D print/textured fabric is, the skin may have indents- but these shouldn’t be sore & they can be massaged out.
- 1-2 fingers should be able to run under the band of the bra
- A finger should fit under the straps
- Worn consistently for the customer to get the full benefits
Maree
Can you explain the range of Amoena products for the following situations?
1. Those that don’t have breast oedema but need to have a well-fitting bra as they have lymphoedema in the arm?
Heidi
The Linda or Leslie bra from our CuraLymph Comfort range would both be suitable for a lady with lymphoedema in the arm. The Linda soft bra is made from a bonded fabric, so it’s very smooth to wear with no seams. The straps & underbust band are wider & designed for comfort. There’s also a panel under the arms that’s created from SensElast technology, it’s a rippled texture & gives the wearer a light massage effect as they’re moving. So to the Leslie bra also has the wider underbust band & straps. It’s been created with a textured fabric for that light massage effect also. Textured fabric may be useful if you suspect oedema as it will leave a dent in the skin after wearing if oedema is present. It’s also pocketed, so she can wear a breast form if needed. Leslie it’s available in a broad size range from 12A up to 28F. If your patient prefers to wear a singlet styled top, then the Liane top may also be a helpful option for her. With a built bra, wide shoulder straps & a textured knit fabric, it provides a light shaping effect & support for the wearer. It’s suitable to exercise or sleep in too.
Linda Compression Bra
Linda underarm textured section
Leslie Compression Bra
Maree
2. Mild breast oedema?
Heidi
The Linda bra may be suitable for mild breast oedema, if your patient doesn’t require compression. It can also be worn with a compression pad if you want to apply light compression to a targeted area.
However, if your patient is requiring medical grade compression to manage her symptoms, I’d suggest the Lymph Flow Long Soft Bra . It’s a Class 1 compression garment with 18mmHg. Wider, adjustable straps & a wider, flared underbust band ensure no pinch points when wearing. The fit can also be adjusted with the rows of hook & eyes at the front opening. A textured, honeycomb knit fabric provides a light massage effect when wearing. A compression pad can easily be worn under the bra if needed. Don’t forget for targeted areas that have fibrosis.
Maree
3. Moderate to severe breast oedema?
Heidi
The Lymph Flow Soft Bra (Class 1 21 mmHg) is more suitable for moderate to severe breast oedema as its created from a bonded fabric and has an increased level of structure. It also features 3D printed patterns on the inside which can provide a light massage when the wearer is moving. The straps can easily be adjusted with hook & loop closures. Front opening with a zip, there is a small magnetic closure to assist when putting on the bra. If more targeted compression needs to be applied to key areas, then I’d suggest adding in the Lymph Flow Pressure Pad. This pressure pad is made from medical grade silicone, with a multi directional texture that easy to clean. For more targeted compression over the breast, the Lymph Flow Breast Shell can be placed into the cup of the compression bra. Easy to cut to size & with raised pearls on the surface, it provides a massage effect.
Lymph Flow Long Compression Bra
Lymph Flow Long front opening detail
Lymph Flow Long textured surface
Lymph Flow Pressure Pads
Breast Shell
Breast Shell in Lymph Flow Long
Maree
Lymphoedema practitioners often find it difficult to find bras that provide enough support for women with large breasts with significant oedema.
Heidi
Feedback from our fitters is that the Lymph Flow Long Soft Bra is a good option for women with large breasts up to 3XL (underbust measurement of 122cm). The knitted fabric accommodates the larger cup sizes & the front opening can be adjusted for a more tailored fit. Although the Lymph Flow Soft Bra is a stiffer and provides greater compression at this stage sizes up to 2XL (117cm underbust).
Lymph Flow Soft Bra
Maree
For those that have chest wall oedema after a mastectomy do you have any products that will assist this?
Heidi
For chest wall oedema, the compression bras that I mentioned previously- the Lymph Flow Long & the Lymph Flow soft bra would be suitable. The Lymph Flow Compression Pad would also be helpful in applying targeted compression to the chest wall. This pad can easily be cut to size if needed. If your patient has had a mastectomy and hasn’t undergone reconstruction, we suggest wearing a breast prosthesis, also known as a breast form. The breast form is designed to be worn in a pocketed bra (all Amoena bras mentioned in this article are pocketed). Wearing a breast form helps to recreate balance in the chest and allow for a compression bra to apply compression more evenly across the chest area. If your patient has an uneven chest wall, or her remaining breast fluctuates in size, the Adapt Air has an adjustable air pocket that conforms to the surface of the chest wall & can be adjusted in size. It can easily be adjusted with a removal air pump.
Maree
This is useful with flattening out scar tissue and provided added compression to areas of oedema compared with a breast form in a pocket.
Breast Forms
