Hidden support for the lionesses: a breast/bra intervention.

Despite health and performance benefits of appropriate breast support in sport, elite women athletes' knowledge of breasts/bras is poor leading to poor bra choices, breast pain and performance decrements. This multiphase intervention assessed breast/bra issues and preferences, individually prescribed sports bras and evaluated outcomes for the England Senior Women footballers. Breast/bra workshops were delivered to England players; all 36 completed pre-intervention surveys and breast/bra assessments, before being prescribed bras six weeks before European and World Championships (2022, 2023). 24 players completed post-intervention surveys. Pre-intervention outcomes identified poor knowledge, poor bra fit, many bra issues, and cultural sensitivities. Breast pain was prevalent (61%), with 25% reporting clinically significant breast pain. Post-intervention, players reported significant improvements with prescribed sports bras. 91% reported improvements in knowledge and benefiting from the intervention. This successful intervention provided an evidence-base for ongoing breast health initiatives with England Teams, plus roll-out to all levels of women's football.

A multi-stage intervention assessing, advising and customising sports bras for elite female British athletes.

Appropriate breast support is recommended in sport; however, what constitutes appropriate support is complex, individual and often sports specific, particularly in elite sport given the wear duration. This intervention educated, assessed and advised elite British female athletes on breasts and bras; those with unresolved issues engaged in bespoke bra interventions. Following educational workshops (n = 80), breast/bra surveys (n = 60), individual bra assessments (n = 37); a rower, shooter, and hockey player participated in the bespoke bra intervention. Eighty-three per cent of athletes rated their breast/bra knowledge as ≤average. Fifty-one per cent experienced breast pain, affecting performance for 29%; seven used medication and one surgery to relieve symptoms. In individual bra assessments most wore ill-fitting, unsupportive bras and wanted bra advice. Bespoke bra interventions eliminated breast pain: for the rower, improved breast position and spine rotation; for the shooter, repositioned tissue and improved performance; and for the hockey player, accommodated smart devices. Whilst bespoke bra development is challenging, most elite athlete breast/bra issues are resolved via education, advice and fitting.

Can we predict the neutral breast position using the gravity-loaded breast position, age, anthropometrics and breast composition data?

BACKGROUND: This study aimed to identify the predictor variables which account for neutral breast position variance using a full independent variable dataset (the gravity-loaded breast position, age and anthropometrics, and magnetic resonance imaging breast composition data), and a simplified independent variable dataset (magnetic resonance imaging breast composition data excluded). METHODS: Breast position (three-dimensional neutral and static gravity-loaded), age, anthropometrics and magnetic resonance imaging breast composition data were collected for 80 females (bra size 32A to 38D). Correlations between the neutral breast position and the gravity-loaded breast position, age, anthropometrics, and magnetic resonance imaging breast composition data were assessed. Multiple linear and multivariate multiple regression models were utilised to predict neutral breast positions, with mean absolute differences and root mean square error comparing observed and predicted neutral breast positions. FINDINGS: Breast volume was the only breast composition variable to contribute as a predictor of the neutral breast position. While ≥69% of the variance in the anteroposterior and mediolateral neutral breast positions were accounted for utilising the gravity-loaded breast position, multivariate multiple regression modelling resulted in mean absolute differences >5 mm. INTERPRETATION: Due to the marginal contribution of breast composition data, a full independent variable dataset may be unnecessary for this application. Additionally, the gravity-loaded breast position, age, anthropometrics, and breast composition data do not successfully predict the neutral breast position. Incorporation of the neutral breast position into breast support garments may enhance bra development. However, further identification of variables which predict the neutral breast position is required.

A multi-phase intervention study of sports bra prescription for elite UK female athletes preparing for the Tokyo Olympics and Paralympics.

Athletes report poor breast/bra knowledge, breast pain, sports bras causing lacerations and chafing, negatively affecting sports performance. No bra interventions to address these issues are reported. Working with 142 UK female athletes preparing for Tokyo Olympics/Paralympics (27 sports), this multi-phase intervention assessed breast/bra knowledge, preferences, issues via surveys and breast/bra assessments. Data were used to develop two sports bras. A total of 112 athletes were prescribed one of the new bras through individual assessments. After four weeks, wear athletes completed evaluations. Pre-intervention breast/bra knowledge was low (83% ≤average), multiple breast/bra issues were reported and most athletes wore ill-fitting, loose bras, offering limited support. Post-intervention, 63% reported improved knowledge and 97% reported their prescribed bra as better than their original bra. Eighty-seven per cent reported benefitting from this intervention, with 17% reporting improved performance. This intervention effectively assessed sports bra needs, developed and implemented solutions, which improved knowledge and potentially performance for some UK athletes.

The effect of washing and wearing on sports bra function.

Sports bras provide support by restricting breast motion during exercise, which may prevent damage to breast structures. Laundering affects the mechanical properties of some sports bra materials. Bra function on the wearer after washing is unreported, meaning sports bra durability is unknown. This intervention study compared subjective and objective performance of sports bras that were washed, and worn/washed, to a control. Twenty-two females were assigned three identical sports bras; control, washed and worn/washed (washed after 60-min wear). Pre-intervention: breast position was recorded while standing and running in each bra. Comfort, fit and aesthetics were rated. Intervention: participants undertook their normal exercise in their worn/washed bra. Post-intervention: after 25 washes (n = 19), pre-intervention testing was repeated. Breast volume and control bra motion were consistent pre/post-intervention; however, post-intervention breast motion increased (20% mediolaterally, 16% superioinferiorly) in washed bras and (32% mediolaterally, 25% superioinferiorly) worn/washed bras. Post-intervention washed, and worn/washed bras were perceived as less supportive and washed bras less comfortable than worn/washed bras. Sports bra support reduced after 25 washes; this was compounded by wear. Participants detected reduced support, but comfort was sustained, suggesting replacement may not be considered. Guidelines on sports bra durability are recommended for breast health.

Multi-study randomised controlled trial to develop, implement and evaluate bra prescription to reduce breast pain and improve quality of life.

BACKGROUND: and Purpose: Breast pain is a common condition presented at breast care clinics and bras are often recommended to reduce symptoms, although criteria and pathways for obtaining appropriate bras are limited. This multi-study, randomised controlled trial (RCT) aimed to establish criteria and performance variables to prescribe bras for breast pain patients, to implement this bra prescription, and evaluate whether, compared to standard care alone, the bra prescription improves breast pain and quality of life (QoL). MATERIALS AND METHODS: Eighteen breast pain patients from a UK hospital were assigned to standard care or bra prescription groups and completed the study. Bra prescription patients were prescribed a bra to wear every day for eight weeks. Patient Global Impression of Change (PGIC), breast pain intensity, QoL, and adherence were assessed. RESULTS: Between-groups there were no differences in baseline breast pain or QoL and no differences in PGIC or breast pain following the intervention. Within-groups, improvements in QoL within bra prescription patients were identified. CONCLUSION: This study developed a framework for bra prescription for breast pain patients and the intervention demonstrated improvements in QoL.

There are two sides to every story: implications of asymmetry on breast support requirements for sports bra manufacturers.

This study aimed to investigate: (1) the prevalence and magnitude of breast movement asymmetry, (2) the interaction between static and dynamic breast asymmetry and (3) the influence of sports bras on breast asymmetry during running. Position data were collected from 167 females whilst treadmill running and then a sub-group of 12 participants in different bra conditions. Breast movement asymmetry existed in 89% of participants, with resultant static breast position asymmetry larger in participants displaying dynamic asymmetry. Asymmetry was most commonly caused (60% to 75%) by greater movement of the left breast. No significant relationships were found between asymmetry and bra size or breast pain. Sports bras reduced asymmetry prevalence from 75% to 33% of participants in the antero-posterior direction but only from 75% to 67% of participants in the infero-superior direction. The magnitude of range-of-motion asymmetry reduced from 67 mm with no bra to between 6 and 64 mm in-bra in the infero-superior direction, with the best performing bra incorporating encapsulating cups and adjustable straps and underband. It is recommended that sports bras allow underband and strap adjustment to facilitate individual breast support and that asymmetry is considered when designing and fitting bras, which could utilise resultant asymmetry measured statically.

A novel multi-study intervention investigating the short and long term effects of a posture bra on whole body and breast kinematics.

BACKGROUND: Poor standing posture has been reported in women with larger breasts, increasing the risk of back pain. Whilst breast reduction surgery can improve posture, conservative measures such as special bras may offer short or long-term relief of symptoms without surgical intervention. RESEARCH QUESTION: This study aimed to utilise a multi-study intervention to investigate the short and long-term kinematic effects of wearing a posture bra. METHODS: Study one utilised biomechanics and physiotherapy expertise to modify the design of a prototype bra to improve posture and breast kinematics; resulting in a second-generation posture bra. To test this bra, 24 females were randomly assigned to control and intervention groups. The control group wore their everyday bra; the intervention group wore the generation 2 posture bra in place of their everyday bra for three months. Pre and post intervention, posture (spine curvature, scapula position, whole body alignment) and breast kinematics were assessed during sitting, standing and walking. Short-term effects of the posture bra were compared to an everyday bra and no bra (study two), whilst the long-term effects were compared using the no bra condition (study three). RESULTS: Biomechanical intervention improved posture and breast kinematics in a prototype posture bra resulting in a second-generation prototype. Pre-intervention, the generation 2 posture bra significantly improved scapula retraction by 6° during both sitting and standing, but also increased deviation of whole body alignment compared to everyday bra and no bra conditions. During walking the posture bra reduced breast motion by 17 % compared to the everyday bra. Following the three-month wearer intervention, scapula depression significantly improved in the intervention group. SIGNIFICANCE: A biomechanically informed posture bra was able to effectively support the breasts and improve scapula position without compromising spinal curvature, reducing the risk of musculoskeletal pain associated with poor posture.

How the characteristics of sports bras affect their performance.

Breast movement reduction (%) measures breast support and sports bra performance, however limited evidence exists on the sports bra characteristics which affect it. This study investigated breast movement reduction achieved by 98 sports bras, the categorisation of support levels, and the characteristics that contribute. Each bra was tested on ∼12 females (total n = 77). Relative breast position was recorded during sports bra and bare-breasted running, and breast movement reduction calculated; low, medium, high breast support tertiles were identified and compared to brand-classified support levels. Ten bra characteristics were identified, and regressions determined which characteristics contributed to performance. Breast movement reduction ranged from 36% to 74%; 69% of bras marketed as high support were in the high support tertile (>63%). Encapsulation style, padded cups, nylon, adjustable underband and high neck drop accounted for 37.1% of breast movement reduction variance. Findings facilitate high performance sports bra development and inform consumer choice. Practitioner summary: Little is known about the biomechanical breast support which sports bras actually provide. This original research facilitates high performance sports bra development, and helps inform consumer choice, by identifying the breast movement reduction of a large sample of sports bras, and the characteristics which impact sports bra performance. Abbreviations: A-P: anterior-posterior; BMI: body mass index; C7: 7th cervical vertebrae; LNIP: left nipple; M-L: medial-lateral; PX: xiphoid process; ROM: range of motion; S-I: superior-inferior; SD: standard deviation; STN: suprasternal notch; T8: 8th thoracic vertebrae.

Breast Education Improves Adolescent Girls' Breast Knowledge, Attitudes to Breasts and Engagement With Positive Breast Habits.

Many females experience breast-related issues that are considered to negatively impact health and well-being. These include breast cancer, issues related to incorrect bra fit, and issues related to breast movement including an increased incidence of breast pain, breast sag, and embarrassment, which can be a barrier to physical activity participation. Knowledge and awareness of these breast issues among females is low. Furthermore, these breast concerns are more prevalent in adolescent girls compared to adult females, with 87% of girls reporting ≥ one breast concern. This study evaluated the short- and longer-term impact of a 50 min breast education intervention on adolescent girls' (11 to 14 years) breast knowledge, attitudes to breasts and engagement with positive breast habits. A mixed methods, controlled, longitudinal, cohort design was employed, using two control schools (n: 412; receiving no intervention) and two intervention schools (n: 375; receiving the intervention) from privileged and less privileged areas. Adolescent girls in four schools completed a validated breast survey pre- and immediately post-intervention as well as 3 and 6 months post-intervention. Additionally, in one intervention school, six focus groups were conducted immediately and 4 months after the intervention. The intervention was equally effective in the two intervention schools. Following the intervention, participants in the intervention schools significantly improved their breast knowledge, their attitudes to breasts and their engagement with positive breast habits, compared to participants in the control schools, p < 0.01 (with large effect sizes). These improvements were sustained 6 months post-intervention. Participants described the session as "informative," it made them "feel less embarrassed" about their breasts; they also reported wanting to do more exercise and to change their bra purchasing and bra wearing habits. These novel, positive findings provide insight into the benefits of teaching adolescent girls about breasts from a young age and can be used to inform effective breast education in schools. It is recommended that education on multiple breast topics should be introduced in schools, preferably being first introduced in primary schools, with a modular structure and progressive information.

Do static and dynamic activities induce potentially damaging breast skin strain?

BACKGROUND/AIM: This study aimed to quantify breast skin strain and strain rate and the effect of support garments at reducing strain and to determine characteristics that correlate with strain during static and dynamic activity. METHODS: 39 women (UK size 32C to 36G) had electromagnetic sensors applied to their breast skin. Sensor coordinates were recorded while standing, walking, running, in no, low and high breast support conditions, plus bare-breasted in the estimated neutral position to calculate strain. Relative breast coordinates and 35 inter-sensor distances identified peak breast skin strain (%) and strain rate (%·s-1), which were then correlated with nipple kinematics, breast pain and participant characteristics. RESULTS: Mean peak breast skin strain was generally <60% during standing, walking and running; however, some individuals exhibited 93% strain in bare-breasted running. Compared with low support, high support did not further reduce strain during standing and walking. Peak breast skin strain/strain rate location was longitudinal, in lateral and medial breast regions and displayed strong correlations with breast volume, body mass index and bust circumference. CONCLUSION: Static and dynamic activity did not result in excessive breast skin strain, suggesting low risk of skin damage. However, during running, some individuals experienced excessive skin strains (up to 93%) and strain rates (up to 1258%·s-1). Breast skin strain/strain rate location suggests lift is required in the lateral and medial bra cup to reduce strain, particularly in larger breast volumes due to increased skin strain risk.

The Kinematics of Breasts Implanted With a Reduced Mass Implant: A Pilot Study.

BACKGROUND: Breast implants may increase breast skin tension and interact with surrounding tissues to alter breast position and motion during dynamic activity. Reducing implant mass and changing implant location (submuscular/subglandular) may also affect breast kinematics and the subsequent loads on breast structures. OBJECTIVES: The aim of this pilot study was to describe the kinematics of breasts augmented with reduced-mass implants during standing, walking, and running, compared with natural breasts, and to provide insight into how implant location (submuscular/subglandular) alters breast kinematics. METHODS: Two breast augmentation participants (12-15 months postsurgery: 32AA presurgery, anatomical submuscular 255 cc B-Lite reduced-mass implant; 32A presurgery, anatomical subglandular 285 cc B-Lite reduced-mass implant) and 2 natural-breasted participants of similar breast size and anthropometrics were recruited. Nipple and torso positional data were recorded with electromagnetic sensors during standing, walking, and running. Nipple kinematics relative to the torso were calculated. RESULTS: The B-Lite participants both displayed greater nipple projection and elevation during standing and a 50% reduction in nipple acceleration during walking, when compared with their natural counterparts. During running, the B-Lite subglandular participant displayed decreased nipple kinematics compared with her natural counterpart and lower nipple kinematics compared with the B-Lite submuscular participant during walking and running. CONCLUSIONS: A combination of implant location (subglandular) and reduced mass minimized nipple kinematics during running. Reducing nipple kinematics during dynamic activity may decrease the loading on breast structures, helping to decrease ptosis and increase the longevity of procedure outcomes.

Breast cancer education for schoolgirls: an exploratory study.

Adolescent girls are an important target group for breast cancer education and promoting breast awareness. However, research has not established schoolgirls' perceived importance of breast cancer education or explored factors that may impact engagement. This study aimed to identify schoolgirls' concerns about breast cancer, desire to know more and perceived importance of breast cancer education, and explored associations with demographic factors. Of 2089 schoolgirls (11-18 years) surveyed, 1958 completed all relevant breast cancer questions and demographic factors (ethnicity, school type, breast size, physical activity level and age). χ-Tests assessed associations between demographics, desire to know more and perceived importance of breast cancer. Overall, 44% of schoolgirls reported concerns about breast cancer, 72% wanted to know more and 77% rated the topic as extremely important. Breast size was not associated with wanting to know more about breast cancer. Schoolgirls who wanted to know more about breast cancer were White, from single-sex schools with boys at sixth form, more physically active and older. However, among other ethnic groups, school types and physical activity levels, the proportion of girls who wanted to know more about breast cancer was still high (≥61%). This study provides evidence of the need for breast cancer education for schoolgirls across all school types, irrespective of breast size or physical activity levels. The results highlight the need to be inclusive and engage schoolgirls from all ethnic groups and to promote breast awareness at a young age to ensure effective breast cancer education.

Breast education for schoolgirls; why, what, when, and how?

Schools are fundamental settings for health education and adolescent females are an important group for promoting positive breast habits. We surveyed 2089 schoolgirls (11-18 years) to provide evidence for, and guidance on, breast education for schoolgirls. 26% reported negative feelings about their breasts and 87% reported ≥ one breast concern. 72% wanted to know more about breast cancer (69% rating this extremely important). >50% wanted to know more about breast sag and breast pain. Preferred delivery format was age eleven (50%), girls only taught sessions (41%) with female teachers (43%). A need for breast education and delivery preferences was identified.