THE BRA FITTING MASTER HANDBOOK - PART 2

Though a bra may seem an innocuous daily item, an ill- fitting one can be extremely harmful, creating constant pressure on a very sensitive part of the body. The risk of impaired lymph movement increases, which can lead to the appearance of edema and inflammation of the mammary gland, as well as discomfort and even pain while wearing the bra. Highly innervated and penetrated by a dense grid of blood vessels, mammary glands are particularly sensitive to temperature, trauma, and above all, to prolonged squeezing. In this regard, understanding the medical and anatomical ramifications as well as making women aware of the many aspects of bra fitting that directly relate to personal health is, in my opinion, extremely important in the work of a bra fitter. Four years ago when I first saw a picture of the lymphatic system of the chest, I immediately noticed one detail: bra straps, underwire, center gore (located between the cups) and underband are exactly where the lymph nodes are located! I then worked with a group of bra fitters, and we learned how to choose the right lingerie for women after a mastectomy (the removal one or both mammary glands) or sector resections. To avoid hampering lymph flow and to prevent lymphedema—which can occur at any point after lymph removal or radiation treatment to the lymph nodes— in the upper limbs on the side of the removed mammary gland, understanding how the lymph nodes function and how to prevent excessive bra pressure in this area was of paramount importance for us.At the same time, I realized that preventing excessive compression of the lymph nodes is an extremely important point not only for women who have undergone mastectomies, but also for women who do not suffer from breast cancer.

ANATOMY LESSON
The structure of the mammary gland
Did you know that the Latin name for the mammary gland – glandula mammaria – also gave its nomenclature to a whole class of vertebrates: mammals (Latin: Mammalia)? The mammary glands are situated symmetrically on the front wall of the chest between the third and sixth or seventh pair of ribs. The distance between them depends on individual structure. Most of the mammary gland is located on the pectoralis major, and only a minor lateral part is situated on the serratus anterior muscle (Bochenek A., Reicher M. Gruczoł sutkowy, Anatomia człowieka, T V. PZWL 2008).The breast is located under the clavicle, limited medially by the edge of the sternum, and limited laterally by the middle axillary line. In the picture you can see that the mammary gland consists of three types of tissue: glandular, located primarily in the areola and nipple, connective and fatty tissues (subcutaneous fat and fatty tissue located behind the gland and between the lobes). The volume of these tissues varies from one individual to the next, therefore, doctors distinguish between two types of breasts: those with predominantly fatty tissue or predominantly glandular tissue. According to studies, the ratio of these tissues in humans is genetically determined and only varies slightly based on hormones or aging. This is why understanding physiological changes and individual client needs are so informative to the process of choosing of a bra.

Why does the breast have this shape?
The mammary glands have a semicircular or conical shape, and function as a paired organ: the body’s largest cutaneous gland. As the mammary glands do not have muscles, but rather overly the pectoralis major muscles, they are naturally held in place by skin, ligaments and fasciae consisting of dense connective tissue. The field of study in the structure of the breast is quite young, however I would like to pay attention to two significant events related to it. The first is the classification of Cooper’s ligaments in 1840. The name comes from the author of their discovery – Astley Cooper. Cooper’s ligaments are connective strips of fibrous tissue that support the breast from above and below and lift it up, thereby helping it to maintain structural integrity. They reach from the skin through the mammary glands to the edge of the pectoral muscle. According to a study by Dr. Joanna Scurr of the University of Portsmouth in the United Kingdom, the strength of these ligaments weakens by 65% in women over 45 years, and the elasticity by 40% compared to younger women.

Lymphatic system
The lymphatic system covers the entire body. If you look at the positioning of the lymphatic system in the chest, you can see that bra straps, underwires and band are situated precisely in those areas where the lymphatic vessels and lymph nodes pass (apical axillary, subscapular axillary, breast, supraclavicular and epigastric).The lymph nodes are located along the efferent lymphatic vessels. They are shaped like a bean and range in size from 2 to 20 mm. They play a crucial role in the normal functioning of the immune system: removing bacteria, viruses and fungi, and collecting lymph with lymphatic vessels. Lymph flows in the lymphatic vessels, which means if too much external pressure is exerted upon them, edemas and even cysts may occur in this area as a result of trauma or incorrect movement of the tissue fluid. It is interesting to note that the more I speak with clients about the structure of the breast and the location of the lymph nodes, and the more I share this knowledge with them and explain the effect that an improper choice of a bra has on their health, the more I see that such sincere communication supports mutual trust and helps build our relationship. In addition, I also obtain useful information; for example, they are more likely to share with me what causes them discomfort when wearing a bra, or the most important elements that they look for in a bra.