The Bra Actually Matters

In over 25 years of taking care of women and their breasts, I have never seen as much “breast pain” as I did during the Covid pandemic. It turns out that, women, sitting at home in their pajamas and comfy clothes, were not wearing bras. And breasts, unsupported, stretched by gravity and movement, were acting out with symptoms of pain. As my patients returned to wearing bras, the “breast pain epidemic” subsided, and my attention turned to educating women about their bras for symptomatic relief.

1) Underwire Bras

Look pretty but do cause discomfort in the inframammary folds (bottom margin of breast and chest wall), sometimes with rubbing irritation of the skin, as well as pressure points over the outer and lower inner aspects of both breasts, at the edges of the wire. Long-term use of underwire bras, rubbing over the lower inner breasts, may cause a “bra bump” (similar to a “pump bump” on the heel of the foot) with a callous feeling of the breast tissue. This is bilateral (one side may be more prominent than the other as one breast is usually slightly bigger, and therefore more compressed, than the other). This feels like a ridge of tissue that your fingers roll over, although there is usually no abnormal finding on ultrasound and often only fat tissue seen in that region mammographically. If this palpable ridge is only on one breast and becomes bigger or more hard or irregular, then absolutely come in for a diagnostic mammogram and ultrasound.

2) Poor Support Bras

Yes, bras do stretch out over time, especially when a woman goes through varying changes of pregnancy, weight changes, and menopause. With poor support, the breasts hang and pull usually over the upper inner chest wall, where pain occurs. Similarly, deep bra strap ruts can form in the patient’s shoulders when they have large pendulous breasts that are poorly supported (resulting in shoulder and back pain), relieved with changing to better support bras or athletic support bras that pull the breasts back “up and in”. Oftentimes, patients try to fit their unequally-sized breasts (the left breast is usually slightly larger than the right) to accommodate their smaller breast, resulting in the larger breast being slightly compressed and irritated. Stores with specialized bra departments offer free bra fittings that help identify the correct size and support for one’s varying size and individual breast tissue.

3) Soft Bras for Sleeping

Many patients find symptomatic relief of breast pain when they wear soft support bras at nighttime, keeping the breasts from “flopping around” and pulling at tissue when one is sleeping. Perhaps one only does this around the menstrual cycle, when the breasts are particularly sore and swollen. I personally love the soft, stretchy bras at Soma, although these may be found at Target and other department stores.

4) Push-up Bras

Often these bras have significant constriction in the bottom part of the breasts, resulting in chest wall / costochondral (breast bone meets the rib cartilage) constriction that may cause tightness and chest wall soreness (inflammation of the rib cartilage, known as costochondritis, is very common in younger women, going away on its own after 4-6 weeks, and alleviated by anti-inflammatory medications as needed for pain; this is usually bilateral, so checking for symptoms on the other side is also reassuring there isn’t anything more serious going on).

5) Athletic Support Bras

Not only utilized with sports activity and seen with increasing athleisure wear, these bras do provide great support and relief of breast pain. Women with large breasts may routinely wear these bras for adequate support and relief of back and shoulder pain. Women who have particularly tender breasts around their menstrual cycle may find relief with wearing an athletic support bra during these days. Be aware of the constriction of the chest wall with the athletic support bra so as not to limit deep inspiration.

6) Binding

Patients hoping to hide breast tissue undergo binding that can cause significant skin irritation and breakdown as well as chest wall constriction and tenderness. Special care of the skin and relaxation or removal of the binding should be regularly performed.

7) No Bra

As mentioned in the introduction, the breast tissue hangs with gravity (and really will reach the belly button with age!) and can cause tenderness at the top of the breast tissue or positional-related pulling in of the nipple with the stretched superior breast ligaments (can be tender as well; goes away with laying down). Certainly, one may feel that they need to “let the puppies breathe!” but be aware that will likely lead to soreness over time, depending on the tissue type as well as other factors such as hormones and caffeine, which increase breast sensitivity.

In conclusion, a large source of breast pain is related to patients’ bras or lack thereof. When breast pain is bilateral, more generalized (not one small area), and in areas of breast pulling / rubbing or on the chest wall, then looking at one’s bra type may help identify the problem. A trial wearing of an athletic support bra for 1-2 weeks (with overnight use of a soft support bra) may help, in which case seeking a better support bra is recommended. For any focal (one area) of pain, particularly if worsening or associated with a palpable lump, contact your physician and schedule a diagnostic mammogram with sonogram (ultrasound). Boutique Breast Imaging is here to help care for you. Scheduling (904) 901-0110.

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