Some women need extra support after bypass surgery

Content provided by the Faculty of the Harvard Medical School

Some women need extra support after bypass surgery

Bras designed for women recovering from bypass surgery may ease pain and minimize infections.

Could a new type of bra help women recover from heart surgery with less pain and fewer infections? That’s the question separate teams of Australian and Canadian nurses are trying to answer.

Standard open-heart surgery for bypassing a blocked coronary artery or repairing a faulty valve starts with an incision down the middle of the chest from the notch at the base of the throat to the top of the abdomen. The surgeon then splits the breastbone and separates the two sides to gain access to the heart. This part of the operation is called a sternotomy, since it opens the sternum, or breastbone. Thanks to the wonders of anesthesia, it doesn’t hurt a bit — until the drugs wear off.

The vest-like CardiBra fastens at the front and the shoulders, making it easy to put on and take off, even when lying down.

Sitting up, turning to the side, taking a deep breath, or other movements that jiggle the breastbone can hurt. So can coughing, sneezing, or anything else that puts pressure on it. The incision, too, can be painful and is prone to infection.

Women have it harder than men — the downward and sideways pull of the breasts can tug on the incision and the fragile breastbone. This tension may cause extra pain and contribute to slower healing. Women with large breasts are most prone to postoperative problems. A study from Mt. Sinai Medical Center in New York showed that women who wore large bra cups (size D or higher) were 38 times more likely than those who wore an A or B cup to develop an infection deep in the healing incision; those who wore a C cup were 12 times more likely to have an infection.

Women preparing for open-heart surgery are usually told to bring a good support bra to the hospital and to wear it after the operation. In theory, this supports the breasts and reduces tension on the incision. In practice, standard bras aren’t necessarily that helpful, especially for women with large breasts. They can’t always be worn right after surgery because they get in the way of drainage tubes and monitoring lines. Reaching for a behind-the-back fastener is painful, as is reaching up to slip into an over-the-head style.

Several companies make bras for women recovering from heart or chest surgery. Do they work? Two nursing teams that have designed their own postoperative support bras are putting the idea to the test.

Testing, testing

At Austin Hospital in Victoria, Austra­lia, cardiac nurse Carolyn Naismith and colleagues designed what they call the CardiBra (see figure). More a vest than a bra, the nylon and Lycra CardiBra has sewn-in breast support cups. It fastens at the front with a plastic zipper that sits on a panel of fabric so it doesn’t come in contact with the incision. Velcro strips along the shoulders allow the CardiBra to open completely and lie flat. This makes it possible to put the vest on or take it off without having to sit up. It also makes it easy for a nurse or doctor to examine the incision or get access to any of the monitoring lines placed on or across the chest.

A pilot study of the CardiBra among 20 large-breasted women undergoing open-heart surgery showed that those who used the CardiBra had slightly less pain for up to six weeks after surgery than those who used a regular bra. They also had less swelling along the incision. As of fall 2005, the Australian team plans to do a larger study to see if these results hold up.

In Alberta, Canada, research nurse Kathryn King and her colleagues designed a similar support bra. As of fall 2005, they are in the midst of testing it in the Women’s Recovery from Sternotomy (WREST) study. In this trial, 215 women wear the new support bra starting within 6–12 hours of surgery, and 215 others wear a standard bra if and when they wish to. King and colleagues are measuring pain and discomfort, wound healing, infection, and the ability to carry out “activities of daily living” such as taking a shower, getting dressed, and cooking meals.

Bring your own support

It remains to be seen whether these trials will show that either of these specialized undergarments eases recovery after open-heart surgery. In the meantime, women preparing for open-heart surgery should bring some sort of support bra to the hospital. Start wearing it as soon as you feel comfortable putting it on. A bra that fastens in front, rather than in back, will be easier to put on and take off.

Breast support isn’t a cure-all for post-bypass pain or infection. But if it can ease either a bit, it’s worth the effort.

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Last updated:	August 21, 2006