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.

Biomechanics of Breast Support for Active Women.

More systematic breast biomechanics research and better translation of the research outcomes are necessary to provide information upon which to design better sports bras and to develop effective evidence-based strategies to alleviate exercise-induced breast pain for women who want to participate in physical activity in comfort.

Treatment strategies to prevent and reduce gynecomastia and/or breast pain caused by antiandrogen therapy for prostate cancer : Statement from the DEGRO working group prostate cancer.

AIM: To provide an overview on the available treatments to prevent and reduce gynecomastia and/or breast pain caused by antiandrogen therapy for prostate cancer. METHODS: The German Society of Radiation Oncology (DEGRO) expert panel summarized available evidence published and assessed the validity of the information on efficacy and treatment-related toxicity. RESULTS: Eight randomized controlled trials and one meta-analysis were identified. Two randomized trials demonstrated that prophylactic radiation therapy (RT) using 1â€¯× 10 Gy or 2â€¯× 6 Gy significantly reduced the rate of gynecomastia but not breast pain, as compared to observation. A randomized dose-finding trial identified the daily dose of 20 mg tamoxifen (TMX) as the most effective prophylactic dose and another randomized trial described that daily TMX use was superior to weekly use. Another randomized trial showed that prophylactic daily TMX is more effective than TMX given at the onset of gynecomastia. Two other randomized trials described that TMX was clearly superior to anastrozole in reducing the risk for gynecomastia and/or breast pain. One comparative randomized trial between prophylactic RT using 1â€¯× 12 Gy and TMX concluded that prophylactic TMX is more effective compared to prophylactic RT and furthermore that TMX appears to be more effective to treat gynecomastia and/or breast pain when symptoms are already present. A meta-analysis confirmed that both prophylactic RT and TMX can reduce the risk of gynecomastia and/or breast pain with TMX being more effective; however, the rate of side effects after TMX including dizziness and hot flushes might be higher than after RT and must be taken into account. Less is known regarding the comparative effectiveness of different radiation fractionation schedules and more modern RT techniques. CONCLUSIONS: Prophylactic RT as well as daily TMX can significantly reduce the incidence of gynecomastia and/or breast pain. TMX appears to be an effective alternative to RT also as a therapeutic treatment in the presence of gynecomastia but its side effects and off-label use must be considered.

Tissue-selective estrogen complex for women who experience breast discomfort or vaginal bleeding when on hormone therapy.

OBJECTIVE: The objective of this study was to evaluate the effects of switching from hormone therapy to tissue-selective estrogen complex (TSEC) in women who experience vaginal bleeding or breast discomfort. METHODS: This retrospective cohort study included 82 postmenopausal women who received TSEC after switching from another hormone therapy due to adverse events. Changes in symptoms and imaging after switching to TSEC were evaluated. RESULTS: The mean age was 56.9 years. The women were switched to TSEC due to vaginal bleeding in 56.1% and breast discomfort in 47.6% (multiple choices were allowed). After the switch, almost all women (97.6%) experienced an improvement in adverse events. However, 27% of the women had worsening of vasomotor symptoms, which was more common when hormone therapy was changed from 2 mg of estradiol (41.7%) compared with 1 mg of estradiol (16.7%), 0.625 mg of conjugated estrogen (30%), or tibolone (12.5%). Images of breast lesions and fibroids before the switch were assessed, showing no change in most women. CONCLUSIONS: This study suggests that TSEC is a good option for women who have breast discomfort or persistent bleeding during other hormone therapy when taking into account the differences in estrogen dose.

An investigation into the prevalence and impact of breast pain, bra issues and breast size on female horse riders.

For female horse riders, breast pain, bra issues and breast size may be important concerns which have yet to be considered. This study aimed to establish the prevalence of breast pain and bra issues in female horse riders and explores the impact of breast size on breast pain and bra issues. A 6-part, 32 question online survey was completed by 1324 females who participated in horse riding activities. Descriptive and chi-squared (χ2) analyses were utilised; data for 1265 participants were included in the final analysis. Breast pain was experienced by 40% of all participants and this was significantly related to self-reported cup size (χ2 = 54.825, P < 0.001), increasing linearly. Breast pain was experienced most frequently during sitting trot and 21% of symptomatic participants reported that breast pain affected their horse riding performance. At least one bra issue was reported by 59% of participants; larger-breasted participants reported experiencing all bra issues more frequently than smaller-breasted participants (P < 0.001). These results demonstrate that educational initiatives are needed to ensure female horse riders are informed about appropriate bra fit and breast support during horse riding to increase comfort and help reduce the potential negative associations with performance.

Is Individualizing Breast Compression during Mammography useful? - Investigations of pain indications during mammography relating to compression force and surface area of the compressed breast.

Purpose The aim of this paper is to determine how the presence of pain during mammographic compression could be reduced. To this end, we examine its relationship with compression force, surface-area of the compressed breast, breast density (ACR) and former operations. Materials and Methods In 199 women 765 mammograms were performed. Women were asked to rate the level of pain on a scale of 0 - 10 (0: no, 10: highest pain). The surface-area of the breast under compression captured by the mammograms was measured using planimetry. 52 of the 199 women were asked to identify the area of the upper body with the highest level of pain. Results The thickness of the compressed breast was 65.2 % of the uncompressed breast at a force of 10 daN (57.8 % at 15 daN). When the force was increased from 10 daN to 15 daN, the average glandular dose (AGD) declined by 17 %. Tolerance of compression was associated with the size of the breast. More than 50 % of the mammograms with a small compression less than 9 daN were associated with higher level of pain. In the oblique projection, 60 % of the women specified the axilla as the area of maximum pain. Conclusion Women with larger breasts tolerated a greater force of compression. This implies a need for individualised examination depending on the size of the breast. Women with increased pain susceptibility terminated the compression early regardless of a small compression less than 9 daN. More than 50 % of the women identified areas outside breast as especially painful. Therefore, during examination, the areas around the breast should also be taken into consideration in order to minimize unnecessary discomfort. Key Points · With increased mammographic compression force, the effectiveness of breast thickness reduction declined.. · A compression force of 15 daN enabled an additional reduction by 17 % in average glandular dose (AGD) compared to 10 daN.. · Tolerance of increased compression force was related to breast surface area.. · Women with increased susceptibility of pain terminated the compression at a low force of less than 9 daN. · Pain relating to the mammographic procedure was identified outside the breast by more than 50 % of the women.. Citation Format · Feder K, Grunert JH. Is Individualizing Breast Compression during Mammography useful? - Investigations of pain indications during mammography relating to compression force and surface area of the compressed breast. Fortschr Röntgenstr 2017; 189: 39 - 48.

Pressure-standardised mammography does not affect visibility, contrast and sharpness of stable lesions.

INTRODUCTION: A recent technological development allows pressure-standardised mammography by personalizing the compression force to the breast size and firmness. The technique has been shown to reduce pain and compression variability between consecutive exams, but also results in a slightly thicker compressed breast during exposure. This raises the question whether visibility, contrast and sharpness of lesions are affected? METHODS: Four experienced radiologists compared 188 stable lesions and structures including (clusters of) calcifications, (oil) cysts and lymph nodes that were visible in mammograms obtained in 2009 with a pain-tolerance limited 18 daN target force compression protocol, and in 2014/2015 obtained with a 10kPa (75mmHg) pressure-standardised compression protocol. Observers were blinded for all DICOM metadata and rated which of the randomly ordered, side by side presented images had better lesion visibility, contrast and sharpness, or whether they saw no difference. They also indicated which overall image they preferred, if any, and whether the non-preferred image was still adequate. Statistical non-inferiority is concluded when the lower limit of the 95% confidence interval of the 4-rater averaged 'new protocol better' proportions exceed the non-inferiority limit of 0.463. RESULTS: In 2014/2015, the compressions were significantly milder, with on average 17% (mediolateral oblique) to 29% (craniocaudal) lower forces. Breasts remained on average 2.4% (1.4mm) thicker. Dose was significantly lower (6.5%), which is explained by glandular atrophy. The 95% confidence interval lower limits are 0.479 for visibility, 0.473 for contrast, 0.488 for sharpness and 0.486 for preference, all exceeding the non-inferiority limit. Of the 60 non-preferred mammograms, multiple observers found only five to be inadequate: 4 obtained with the force protocol and 1 with the pressure protocol. CONCLUSION: Pain-reduced mammography with 10kPa pressure-standardised compression has non-inferior visibility, contrast and sharpness for stable lesions compared to pain-tolerance limited 18daN target force compression.

The effect of breast support and breast pain on upper-extremity kinematics during running: implications for females with large breasts.

The relationship between inappropriate breast support and upper-extremity kinematics for female runners is unclear. The purpose of this study was to investigate the effect of breast support and breast pain on upper-extremity kinematics during running. Eleven female recreational runners with larger breasts (UK D and E cup) completed a 7 min 20 s treadmill run (2.58 m · s(-1)) in a high and low breast support condition. Multi-planar breast and upper-extremity kinematic data were captured in each breast support condition by eight infrared cameras for 30 s towards the end of the run. Breast pain was rated at the end of each treadmill run using a numeric analogue scale. The high support bra reduced breast kinematics and decreased breast pain (P < 0.05). Upper-extremity kinematics did not differ between breast support conditions (P > 0.05), although some moderate positive correlations were found between thorax range of motion and breast kinematics (r = 0.54 to 0.73). Thorax and arm kinematics do not appear to be influenced by breast support level in female runners with large breasts. A high support bra that offers good multi-planar breast support is recommended for female runners with larger breasts to reduce breast pain.

[Systemic Adamantiades-Behçet's disease: adverse effects of an otherwise successful therapy with interferon-α-2a]. / Morbus Adamantiades-Behçet: erfolgreiche Therapie mit ungewöhnlichen Komplikationen.

BACKGROUND: Adamantiades-Behçet's disease is an immune-mediated vasculitis with relapsing course. It is characterised by the classic clinical trias of oral aphthous ulcers, genital ulcers and uveitis. HISTORY AND FINDINGS: A 37-year-old woman suffered from systemic Adamantiades-Behçet disease with recurrent uveitis, oral ulcers, genital ulcers, arthralgia, erythema nodosum and folliculitis. COURSE AND TREATMENT: Longterm interferon-α-2a (IFNα-2a) led to reduction of the clinical manifestations except for occasional occurrence of oral ulcers. One year after initiation of treatment however, the patient developed symptomatic hyperprolactinemia of unknown etiology. CONCLUSION: Even in otherwise successful treatment with IFNα-2a possible side effects and complications of treatment can affect the course. Mastodynia and hyperprolactinemia have not yet been described as potential side effects of IFNα-2a.

The Influence of the Breast on Physical Activity Participation in Females.

BACKGROUND: The importance of physical activity is well known. However, previous research suggests that breast movement during exercise can be painful, embarrassing, and anecdotally deter exercise participation. Therefore, this research investigates whether the breast influences physical activity participation. METHODS: Female respondents (n = 249) completed a breast health and physical activity survey assessing bras and bra fit, physical activity, breast pain, comments and improvements, breast history, and demographics. RESULTS: Results found that the breast was a barrier to physical activity participation for 17% of women. "I can't find the right sports bra" and "I am embarrassed by excessive breast movement" were the most influential breast related barriers to activity. Breast pain increased with vigorous activity and poor breast support. Breast health knowledge increased the use of a sports bra and levels of physical activity. CONCLUSIONS: The breast was the fourth greatest barrier to physical activity, behind energy/motivation (first), time constraints (second), and health (third), despite its omission from previous physical activity literature. As 33% of women were not meeting physical activity guidelines, increasing breast health knowledge may reduce barriers to physical activity.

[Effect of change to flutamide for prostate cancer patient who developed breast pain during bicalutamide treatment (BIP-F study)].

In Japan, prostate cancer is treated with non-steroidal anti-androgen (flutamide and bicalutamide). Development of breast pain during bicalutamide treatment, in prostate cancer patients reduces their quality of life (QOL) and treatment compliance. We studied the safety and effectiveness of switching from bicalutamide to flutamide in 13 prostate cancer patients who developed breast pain during bicalutamide treatment. We estimated the change in breast pain using a face scale and the Expanded Prostate Cancer Index Composite (EPIC) and EPIC-hormone domain (HD) score. The switch to flutamide relieved breast pain in nine patients, had no effect in one patient, and increased breast pain in two patients. One patient dropped out. Furthermore, summary score and hormone function were improved with a significant difference in the EPIC-HD score. Switching to flutamide in prostate cancer patients who develop breast pain during bicalutamide is safe and effective.

An investigation into breast support and sports bra use in female runners of the 2012 London Marathon.

Although it is acknowledged that appropriate breast support during exercise is important, no published literature has assessed breast support usage in a cohort of female marathon runners. This study aimed to identify sport bra use and perceived importance of sports bra use in female marathon runners. Bra satisfaction, incidence of bra related issues and factors that influence the appropriateness of sports bras were also investigated. A 4-part, 30-question survey was administered to 1397 female runners at the 2012 London marathon registration and via an online survey. In total 1285 surveys were completed. Sports bra use and its perceived importance was high, however was lower in moderate compared to vigorous activity, and lower in participants with smaller breasts. Seventy-five per cent of participants reported bra fit issues. The most common issues were chaffing and shoulder straps digging in, with a higher incidence of issues reported by participants with larger breasts. Use of professional bra fitting was low, and perceived knowledge of breast health was poor. Engagement with sports bra use is high although sports bra design could be improved to alleviate bra fit issues experienced by female runners. Educational initiatives are needed to ensure females are informed regarding the importance of breast support and appropriate bra fit during activity.

Effects of strap cushions and strap orientation on comfort and sports bra performance.

PURPOSE: This study aimed to quantify bra shoulder strap pressures, to investigate how bra strap cushions moderated this pressure and increased comfort, and to investigate the effects of variations in bra shoulder strap configuration on vertical breast motion, breast discomfort, shoulder pressures, and comfort. METHODS: Fourteen healthy women (C+ bra cup size) ran on a treadmill wearing a sports bra under five strap conditions (no straps, traditional vertical alignment, crossed-back alignment, and with and without bra strap cushions inserted under the straps). Bra shoulder strap pressure, vertical breast displacement, breast pain, and shoulder comfort were measured during each trial. RESULTS: Maximal pressures from 0.83 to 2.67 N·cm and mean pressures from 0.52 to 1.06 N·cm were recorded during running. The bra strap cushions only reduced maximal shoulder strap pressure in the crossed-back strap orientation. Vertical breast displacement was significantly less in the crossed-back orientation compared with no straps, and breast pain was significantly reduced in both the traditional and crossed-back orientation compared with the no strap condition. No significant between-condition difference was found in shoulder comfort regardless of shoulder strap orientation, although the crossed-back strap orientation resulted in significant increases in shoulder force and mean pressure values compared with the traditional strap orientation. CONCLUSION: The bra shoulder strap cushion was not effective in decreasing the bra shoulder strap pressure due to design flaws that prevented it from adequately increasing the strap-shoulder contact area. However, modifying shoulder strap orientation from a traditional to a crossed-back configuration could alleviate the common problem of bra shoulder straps slipping off the shoulders of the wearer, without decreasing the overall efficacy of the sports bra in providing breast support.

[A micro-education programme for breastfeeding women: a pilot study to investigate the educations' effect on injured and painful nipples]. / Mikroschulungsprogramm für stillende Wöchnerinnen: Pilotstudie zur Auswirkung der Schulungen auf schmerzende und wunde Mamillen.

Injured and painful nipples are frequently occurring events in nursing women during the first days after giving birth. These problems often result in a premature termination of breastfeeding despite the mother's wish to nurse. Unsystematic instructions given to women regarding correct breastfeeding increase the risk that these complications will arise. The objective of the study was to investigate the effect of a systematic micro-education programme for nursing women by means of a pilot study or a quasi-experiment. The study included 100 mother and child pairs each in the experimental group and in the control group (N = 200). The pain experienced by all women during nursing was measured using the Visual Analogue Scale (VAS) and the degree of injury to the nipples after nursing was measured with a tool specially developed for this purpose, the Nipple Wound Score (NWS). Women who received instructions by means of the micro-education programme exhibited significantly less injured nipples (on the third day: experimental group 55 % and control group 77 %, p < 0.00; on the fourth day: 56 % and 80 %, p < 0.00).No differences were observed between the study groups in regard to the occurrence of pain (on the fourth day p = 0.68). The variables of birthing method, parity, age or nationality of the women had no effect on the degree of injury of the nipples or on the intensity of pain. The results of this pilot study suggest that repeated micro-education for breastfeeding women should be implemented during the first days after giving birth.

Tamoxifen for the management of breast events induced by non-steroidal antiandrogens in patients with prostate cancer: a systematic review.

BACKGROUND: Tamoxifen has emerged as a potential management option for gynecomastia and breast pain due to non-steroidal antiandrogens, and it is considered an alternative to surgery or radiotherapy. The objective of this systematic review was to assess the benefits and harms of tamoxifen, in comparison to other treatment options, for either the prophylaxis or treatment of breast events induced by non-steroidal antiandrogens in prostate cancer patients. METHODS: We searched CENTRAL, MEDLINE, EMBASE, reference lists, the abstracts of three major conferences and three trial registers to identify ongoing randomized controlled trials (RCTs). Two authors independently screened the articles identified, assessed the trial quality and extracted data. The protocol was prospectively registered (CRD42011001320; http://www.crd.york.ac.uk/PROSPERO). RESULTS: Four studies were identified. Tamoxifen significantly reduced the risk of suffering from gynecomastia (risk ratio 9RR0 0.10, 95% CI 0.05 to 0.22) or breast pain (RR 0.06, 95% CI 0.02 to 0.17) at six months compared to untreated controls. Tamoxifen also showed a significant benefit for the prevention of gynecomastia (RR 0.22, 95% CI 0.08 to 0.58) and breast pain (RR 0.25, 95% CI 0.10 to 0.64) when compared to anastrozole after a median of 12 months. One study showed a significant benefit of tamoxifen for the prevention of gynecomastia (RR 0.24, 95% CI 0.09 to 0.65) and breast pain (RR 0.20, 95% CI 0.06 to 0.65) when compared with radiotherapy at six months. Radiotherapy increased the risk of suffering from nipple erythema and skin irritation, but there were no significant differences for any other adverse events (all P>0.05). CONCLUSIONS: The currently available evidence suggests good efficacy of tamoxifen for the prevention and treatment of breast events induced by non-steroidal antiandrogens. The impact of tamoxifen therapy on long-term adverse events, disease progression and survival remains unclear. Further large, well-designed RCTs, including long-term follow-ups, are warranted. Also, the optimal dose needs to be clarified.

Prevention of gynecomastia and breast pain caused by androgen deprivation therapy in prostate cancer: tamoxifen or radiotherapy?

PURPOSE: To determine, in a meta-analysis, whether gynecomastia and breast pain rates in men with prostate cancer treated with androgen deprivation therapy (ADT) are reduced if treated with prophylactic radiotherapy (RT) or tamoxifen (TMX). METHODS AND MATERIALS: The MEDLINE, EMBASE, CANCERLIT, and Cochrane Library databases, as well as proceedings of annual meetings, were systematically searched to identify randomized, controlled studies comparing RT or TMX with observation for men with prostate cancer using ADT. RESULTS: Six RCTs (three RT trials and three TMX trials, N = 777 patients total) were identified that met the study criteria. Pooled results from these RCTs comparing RT vs. observation showed a significant reduction in the incidence of gynecomastia and breast pain rates in patients treated with RT (odds ratio [OR] = 0.21, 95% confidence interval [CI] = 0.12-0.37, p < 0.0001, and OR = 0.34, 95% CI 0.20-0.57, p < 0.0001, respectively). Use of RT resulted in an absolute risk reduction (ARR) of 29.4% and 19.9%, with a number needed to treat (NNT) of 3.4 and 5 to avoid one case of gynecomastia and breast pain, respectively. Pooled results from trials comparing TMX vs. observation showed a statistical benefit for breast pain and gynecomastia in favor of TMX arms (OR = 0.04, 95% CI = 0.02-0.08, p < 0.0001 and OR = 0.07, 95% CI = 0.0-0.14, p < 0.00001). TMX resulted in an ARR = 64.1% and 47.6%, with an NNT of 1.56 and 2.1 to avoid one case of gynecomastia and breast pain, respectively. Considering adverse effects, TMX was 6 times more adverse effects than RT. CONCLUSIONS: Our data have shown that both TMX and RT prevented gynecomastia and breast pain in patients with prostate cancer receiving ADT for prostate cancer. Although TMX was two times more effective in preventing gynecomastia, RT should represent an effective and safe treatment option, to take into account mainly in patients with cardiovascular risk factors or thrombotic diathesis.

Features of sports bras that deter their use by Australian women.

OBJECTIVES: This study aimed to identify features of commercially available sports bras that deter women from wearing them while participating in physical activity. DESIGN: Study results were obtained from a self-administered mail survey, which was posted to participants after gaining their verbal consent via random telephone recruitment. METHODS: Four hundred and thirteen women aged 20-35 years were recruited from New South Wales, Australia, with 267 (65%) surveys returned. RESULTS: It was found that the shoulder straps slipping or cutting into the shoulder were the two most disliked features of current sports bras, with 23% of respondents also indicating that the shoulder straps were the first bra feature to fail. Respondents also indicated that the perceived tightness of the sports bra around the chest was a deterrent for their use. CONCLUSIONS: Although previous research has found that a correctly fitted sports bra does not impede athletic performance, further research is required to investigate sports bra shoulder strap designs to improve wearer comfort without negatively affecting the ability of a sports bra to reduce breast motion and/or associated breast pain during participation in physical activity.