Her bra research led to better post-surgery care

A common question among patients piqued the curiosity of the Breast Cancer Clinic staff. What is the best bra to use after surgery to reduce pain? Lacking reliable evidence, Malin Bachman decided to conduct a study.

At the Karolinska University Hospital, about 1,000 breast implants are performed each year. To protect the newly operated breast and reduce pain, patients are advised to wear some type of bra after surgery. Bras also reduce the risk of complications such as swelling and fluid buildup, known as seroma.

Previously, the overwhelming majority of women were offered a softer and simpler model. After some probing, the staff recommended a firmer bra with some compression with wide straps and underwire. But there has been a lack of knowledge about which of the two models offers the most benefit.

– Some surgeons were very clear about the model to be used, while others handed the responsibility over to the nurse. But there was no scientific evidence that one bra or the other relieved symptoms any better. It wasn’t enough, Malin Backman says, we have to act on the evidence.

undiscovered area

As a nurse practitioner, she looked for answers in the research, but soon realized there were no studies in postoperative bra support following breast cancer surgery.

– At the same time, we know from previous studies that up to 60 percent of women experience pain some time after the operation. If the pain is not relieved immediately, there is a risk that it will last for a long time, or even permanent, Malin Backman says.

I applied for financial funding, ethical approval and planned a randomized study comparing two different bra options. Included were 200 women randomly assigned to use either a firmer bra or a softer model. Participants were asked to wear bras as much as possible at all hours of the day for three weeks after surgery and all had to fill out symptom forms before and three weeks after surgery.

In a diary, participants recorded adherence to bra use, pain on a numeric scale from zero to ten, NRS, and use of pain relievers. They also answered questions about satisfaction with the bra after surgery, comfort, convenience, and mobility.

The stable support gave less pain

The results showed that compliance was high regardless of the group — on average, the women used the bras for 22 hours a day. There was also no difference between the groups with regard to pain, analgesic intake, other symptoms, and the incidence of complications. A significant proportion of patients, 68 percent, reported pain of a grade of 3 or higher in the first 14 days regardless of which bra they used. After three weeks, nearly half, 46 percent, still had some soreness in the operated breast.

For the group of women who reported pain three weeks after surgery, it was found to be significantly less in those who used a firm bra than in those who used a soft bra. At the same time, the participants who used stability bras experienced a higher degree of comfort, a higher sense of security during activity and in everyday life, and higher support and stability compared to the other group.

It’s interesting and important that we can now show that there are differences between the different models, especially for women who have pain issues after surgery, says Malin Backman.

With new evidence behind it, the Breast Center at Karolinska University Hospital has now changed its routine. Primarily, a stable sling is recommended – if the procedure requires nothing else. The responsible surgeon must clearly document the type of bra the patient should use after the operation.

– The study also taught us to be more careful about giving the right size for the best comfort and fit. We have gained a greater understanding of the importance of bras as an apparel for women. Those who wear bras know how uncomfortable it can be if they are too loose or too tight.

The interest from colleagues is high, and Malin Bachman now somewhat jokingly calls herself the bra expert. The results of the study were presented both nationally and internationally. The study was recently published in the Scientific Journal European Journal of Oncology Nursing.

However, the NCP hasn’t changed, but more studies are needed to confirm the findings, Malin Bachman says.

“We wanted to check which bra would fit different types of procedures, but then we had to include a lot more patients,” she says.

improves care

Malin Backman and her colleagues are currently analyzing qualitative data collected during the study. Here they will receive more detailed information about the importance of a postoperative bra after breast cancer surgery. Results will likely be published in the fall.

A positive side effect of the study was the increased interest of nurses in care research. It feels so fun! We need to become more researchers who can contribute to improving the care of people with different diseases.

– Even if we don’t save lives with this type of study, we improve postoperative care for our patients by reducing symptom burden and increasing quality of life. That we act on the basis of evidence is an absolute requirement in healthcare.