Breasts are the unsung heroes of motherhood but often soldier on without the support they need. Renée Vincent explains why and how we should show them more love.
The childbearing years can be hard on a woman’s breasts. With changes during pregnancy and then the process of breastfeeding one or more children, many mums feel that their breasts are not what they were before children. Yet considering the degree to which breasts are affected by pregnancy and breastfeeding, most of us mums still give very little thought to looking after these amazing parts of our bodies. New mums usually only stop to consider breast care if it impacts on their ability to breastfeed, and therefore their baby’s health. They tend not to think of their own health and how breast care contributes to it.
While women today are much more aware of the need to check their breasts for signs of breast cancer, this article hopes to bring other aspects of breast care onto the radar too. I’ll cover two breast-care-related topics I deal with in my work as a women’s health physio. Firstly, advising women on good bra support both during pregnancy and postnatally; and secondly, helping with a breakdown in breast milk flow, caused by blocked milk ducts, using therapeutic ultrasound.
Are you getting the right support
Recent research conducted by Breast Research Australia found that 85% of women are wearing the wrong size bra. Facing a reduced income, pregnant women tend to cut costs by putting up with their existing bras during pregnancy, even though breast size can fluctuate by one or more cup sizes. Often they’ll invest in breastfeeding bras at the end of their pregnancy and stick with the same bras throughout baby’s first year, ignoring fluctuations in breast size as their breastfeeding changes.
Wearing the wrong size bra is not only uncomfortable, it can also affect support. Biomechanical studies of the breast show that there is a significant difference in breast volume with change in bra size. A size 10D breast may be 400ml in volume, while a size 16D may be 1500ml. As breast size increases, support becomes more important. Without the right support, the weight of the breasts can pull women into a slouched posture, which can lead to headaches and neck, back or arm pain.
For larger-breasted women, wearing a correctly fitting bra is especially important during exercise as, not only are larger breasts heavier, they also move more. As the body rotates and moves up and down, the breasts swing in a 3D bouncing movement and also slap against the chest or abdominal wall. Female breasts contain no substantial anatomical support apart from the skin and fine hair-like connective tissue called Cooper’s ligaments.
Dr Deirdre McGhee of Breast Research Australia is a sports physiotherapist who has studied the effects of bra fit on breast support. Her research has demonstrated that breast support during physical activity is an important, but often neglected, women’s health issue. Her findings led to the first ever guideline for women on Exercise and Breast Support, which educates women of all ages about how important it is to wear a correctly fitted bra.
Women’s breasts change a lot during pregnancy and postnatally, so being aware of what a correctly supporting bra feels, looks and performs like is very important. And many mothers don’t just do structured exercise, they’re physically active all day, running after their children. Therefore it is doubly important (excuse the pun) that women feel that spending money on a few extra bras during this time is a valuable use of limited funds. According to McGhee, the factors women need to take into account when choosing a good bra are:
🌸 how much movement the breast will do during the activities they take part in
🌸 how much breast discomfort is felt when they are active (ideally nil to mild)
🌸 how long they are active for (during a 60 minute run the breast would bounce 10,000 times, so as the hours of exercise per week increase, so should support)
🌸 how large their breasts are
🌸 how old they are (anatomical support declines with age, so if you’re 40+, you need more support)
Different types of bra suit different types of activity. Women should perform some of the exercises they want to do in the change room to assess if the bra provides adequate support.
Bra fit checklist
Band: Not too tight; no flesh bulging over the top of the band (too small); doesn’t ride up when your arms are raised (too big). Ideally you should fasten a new bra on the loosest hook so you can tighten it up as the bra stretches with age.
Straps: Comfortable, not digging in, not sliding off.
Cup: No breast bulge over the top of the cup (too small); no wrinkles or gaps in the cup (too big).
Underwire: Sits on your ribs, not on your breast tissue at the front or under your armpits (too small or the design does not fit your breast shape). Front band: Sits flat against your breast bone.
Restoring the flow - dealing with blocked milk ducts
The World Health Organisation strongly recommends breastfeeding as it provides optimal nutrition for baby. Through its Baby Friendly Hospitals Initiative, women are meant to be supported with their breastfeeding and helped to bond with their baby. However, many women report feeling pressure rather than support, and guilt when they find they have breastfeeding problems. This is very unfortunate as breastfeeding has a surprisingly high failure rate. Studies report between 12% and 44% of babies receive suboptimal nutrition.
It should be expected that women will face a few obstacles when breastfeeding, and new mothers should be provided with plenty of support and options so they can find their way at this potentially difficult time. One obstacle that can cause a lot of distress is blocked milk ducts. When this happens milk build-up leads to engorgement of the breast tissue. You might feel this as a lump and it may also be sore and red. When milk is forced into the surrounding tissue and it becomes inflamed, mastitis develops. This tends to have more severe symptoms and may involve an infection of the breast tissue, causing you to feel unwell and have a fever.
Women’s health physios can treat blocked milk ducts with therapeutic ultrasound, often clearing the blockage before it progresses to full-blown mastitis. This is similar to a diagnostic ultrasound, except there is no visual screen and the head of the ultrasound may become warm. The therapist puts warm water-based gel on the head of the ultrasound and massages each quarter of the breast with the ultrasound head for 8–10 minutes. The ultrasound sends high frequency sound waves through the breast tissue, which causes a micro-massage effect along with the massaging of the treatment head.
Following treatment you’re asked to breastfeed to encourage milk through the newly softened or cleared blockage. The breast often feels a lot softer and less engorged and feeding is usually easier. It can take one to three treatments to get the full effect. Very occasionally, recurring blockages need more, or treatment on and off through the breastfeeding period.
Ultrasound complements, rather than replaces, traditional self-care to relieve a blocked duct. The Australian Breastfeeding Association recommends the following self-care.
🌸 Start treatment as soon as you feel a lump or sore spot.
🌸 Rest as much as possible.
🌸 Keep the affected breast as empty as possible by feeding from that side as often as you can.
🌸 Apply warmth to the affected breast area before a feed.
🌸 Feed from the affected breast first, when baby is sucking vigorously.
🌸 Check that your baby is attached well and can get the milk easily.
🌸 Relax to help your let-down reflex work well.
🌸 Gently but firmly massage the lump toward the nipple during (and after) feeds.
🌸 Change feeding positions to help empty the breast (having baby lower than the blockage can help).
🌸 Hand express, if necessary, before and after feeds.
🌸 Cold packs after a feed may help relieve pain and inflammation.
See your medical adviser if you cannot clear the lump in a few days, or sooner if you develop a fever or feel unwell.
Hopefully you’ll now be thinking about how you can treat your breasts to the care and attention they deserve, and feeling inclined to rummage through your lingerie drawer to check whether your bras are providing the right support for the activity you are doing. Definitely don’t let breast discomfort put you off exercising, as even if you have to wear a combination of bras (eg a sports bra and a crop top) to get enough support, you want to keep up the exercise. If you have trouble finding the support you need, then seek some professional advice from a trained bra fitting attendant in a reputable lingerie store. Or consult the Breast Research Australia website or app: bra.edu.au/sportsbra/.
If you’re a breastfeeding mother who is struggling with blocked ducts then definitely don’t suffer in silence. See if your GP, midwife or lactation consultant can refer you to a women’s health physio experienced in giving ultrasound treatment to breast tissue. It may just be the extra bit of help you need to keep your breastfeeding going. It’s not always easy, but there is plenty of good evidence to show the benefits of breastfeeding are worth it if you can find a way through for you and ‘the girls’.
OHbaby! fitness expert Renée Vincent is a physiotherapist at Total Mums in Auckland and mum to an energetic young son.