Post-surgical drains are used to reduce the risk of seroma formation following breast surgery.¹³ Though the routine placement of surgical drains has decreased, they are still used regularly following mastectomies, axillary dissections, and oncoplastic and reconstructive procedures. As these operations have become day procedures, patients are increasingly discharged home with drains in situ. Patients have difficulties with drainage care, sometimes inadvertently leading to early accidental removal, and some patients find it embarrassing to carry around drainage bottles in front of others.²⁸ Innovative post-surgical garments that include pockets to hold tubing and drains allow women to continue their daily activities without tubes getting in the way, tubes being pulled out, and allow patients independence without these surgical accessories being noted by others.²⁵ Shima et al. examined clinical outcomes such as seroma formation and surgical site infection when comparing early versus late drain removal. Their findings suggest that appropriate post-operative garment design could complement drain management strategies by providing consistent compression after drain removal, potentially reducing late seroma formation.¹³ Similarly, Chadha et al. found that patients discharged with drains in situ experienced challenges with drain management that appropriate garment design could address, potentially improving wound healing outcomes.²⁸

Conventional post-surgical garments lack features to secure tubes or carry drains, often complicating recovery. There is a clear need for improvement in the design to include a feature for both the tubing as well as the drain.

Thermal dysregulation is an unfortunately accepted side-effect that many women experience with the necessary adjuvant treatment for breast cancer. Additionally, the use of prostheses has also been associated with increased heat trapping. Many patients are frustrated by this issue of heat and moisture build up. Unfortunately, the conventional mastectomy bras do not allow proper airflow which, compounded with the use of prosthesis and heavy padding, leads to overall patient dissatisfaction.¹⁷ A smaller scale study has demonstrated that a heat-reducing mastectomy bra leads to optimal thermal comfort and improves patient satisfaction.¹⁷ A mixed-methods study by Ng et al. evaluated patient experiences with a conventional standard-sized bra and prosthesis set versus a customized hand-knitted external breast prosthesis used with the patient’s own bra, among 148 Asian women post-mastectomy.⁷ The majority (67%) preferred the customized option, citing significantly less sweating (P < 0.0001), greater comfort (P = 0.0195), and lower dislodgement rates (P = 0.0269). Qualitative data highlighted improved confidence, sense of normalcy, and greater emotional ease with the customized prosthesis. Although both options reduced perceived disfigurement, the ability to use one’s own bra and the breathability of the hand-knit prosthesis were key drivers of preference, suggesting value in tailoring undergarment solutions to individual comfort and lifestyle needs.⁷ Thermoregulation remains an unaddressed issue by the majority of conventional post-operative garments.

Breast surgery compounded with radiation therapy can often lead to increased dermal sensitivity. It is important, especially in the early post-operative period, that care be taken to ensure comfortable garments that do not magnify post-operative discomfort. Unfortunately, most post-operative undergarments available use materials that aggravate the skin. For example, post-mastectomy bras often use Velcro to allow for front closure. While this may improve accessibility to put on and remove the garment, this does introduce potential harm to the underlying dressing and skin. Moreover, breast surgery is often accompanied by axillary surgery and radiation treatment. These therapies increase the risk of lymphedema in the ipsilateral breast, chest, and upper extremity. Most conventional post-operative brassieres do not account for these possible complications. The standard straps, bands, and cup length can cause discomfort and pain beyond that already experienced by patients.¹⁶ Overall, the current undergarments available fail to provide the necessary comfort and can exacerbate post-operative adverse symptoms.

A common problem faced by women, even those that are not breast cancer survivors, is wearing incorrectly sized bras. It has been reported that up to 85% of women wear incorrectly fitted bras and that poor fit is correlated with breast size.¹⁵ This difficulty arises from the natural asymmetry of the breasts. In the general population, studies have demonstrated that wearing a poorly fitted bra can lead to increased pain, poor posture, fatigue, and musculoskeletal problems.¹⁰ This problem is even more pronounced after breast surgery, as a significant portion, if not the entire breast, has been removed. Current evidence supports a biomechanically informed posture bra to support heavier breasts and improve posture, and reduce musculoskeletal pain.¹⁰ Non-medical bras do not account for this emphasized imbalance and do not provide sufficient support.¹⁵ In a prospective study from Japan, Watanabe et al. assessed the impact of a semi-customized, professionally fitted brassiere on post-operative recovery among 46 women following breast reconstruction.⁸ The bras were selected and fitted by trained specialists to match each patient's unique anatomy and provided ongoing support through scheduled follow-ups. The bras featured soft, adjustable designs tailored to reconstructed breasts, with attention to minimizing pressure on sensitive areas and surgical scars. The intervention led to significant reductions in post-operative pain at all measured time points (P < 0.001 at 1, 3, and 6 months; P = 0.007 at 12 months) and significantly improved patient satisfaction and confidence when wearing bras. Aesthetic ratings of breast shape and symmetry were also significantly better with the bra in place, especially at 3 and 6 months post-op. Additionally, consistent use of the custom-fitted bra reduced anxiety, contributed to a greater sense of safety, and promoted adherence to wearing supportive garments in daily life. These findings emphasize the critical role of a personalized fit in optimizing outcomes after breast reconstruction.

Many post-operative breast surgery patients will require long-term adjuvant therapy that increases the risk of hot flashes. For this reason, a common source of frustration in conventional mastectomy undergarments is the use of materials that promote heat trapping. To generate more airflow, multiple design features have been developed to counteract the presence of sweat. A study by Kristina Shin et al.¹⁷ explored the design of a post-operative garment that addressed this important problem. One solution that has been proposed is the use of a mastectomy bra, which contains holes at the bottom of the cup to promote ventilation. Another consideration has been to create a prosthesis that contains ventilation holes to reduce heat generated by prosthetics.¹⁷ Overall, this addresses the problem by allowing heat to pass through both the garment as well as the prosthesis. When comparing this garment to the standard model during exercise, women experience less humidity and overall lower skin temperature.¹⁷

An alternative method that has been investigated as a potential solution to contribute to the reduction of perspiration and heat around the breasts is the use of more breathable and cooling textiles in the design of post-operative garments. Although there has been no empirical research on the use of lighter fabrics, surveys of breast cancer survivors have made suggestions advocating for the use of lighter, more breathable fabrics to increase airflow in order to dissipate heat and promote the cooling of the breasts.²³ Materials that contain anti-wicking properties were found to be favorable. Additionally, developing a bra with lighter fabrics also improves heat trapping, assists in creating airflow, and in turn creates less sweat, and improves patient comfort.⁹

The use of front opening mastectomy bras has been regarded as practical given their ability to facilitate accessibility in the post-operative recovery period. Most breast cancer patients will undergo some form of axillary surgery which in turn leads to limitations in the range of motion of the arm. The front opening mastectomy bra helps alleviate some of these difficulties.

Many different fasteners are currently on the market, including Velcro and zipper fasteners. The drawbacks of the current models are that they can irritate sensitive skin, get caught by the underlying bandages protecting the wound, and overall cause harm to the patient. These shortcomings call for other mechanisms to be explored. Examples that have been put forward are the standard eye hooks and clips. These options are interesting as they avoid the aforementioned issues that are encountered in the early post-operative period and still maintain the front-opening solution.

A common issue that arose amongst breast cancer survivors regarding the post-operative bra is the grievance associated with the underwire of the bra. A study by Wroblewski et al.¹⁶ found that most patients reported that their preferred design would not include an underwire. These women described a sense of discomfort and tactile irritation associated with the wire. Though there is not a large body of evidence on the effects of the underwire on the post-operative breast surgery patient, it is understood that they are disliked by a significant number of patients.

While some specialty manufacturers now produce post-breast surgery bras with adjustable straps, Wroblewski et al.¹⁶ found that many patients still report accessing models without this important feature, suggesting inconsistent availability or awareness of better-designed options. Adjustable straps would allow for lengthening of the bra and creating a more customizable design.

Another observation made by breast cancer survivors is the discomfort associated with the bra straps and bands of the conventional mastectomy bra. Furthermore, breast cancer survivors have advocated for softer materials that make up the bra straps and bands as well as wider straps to provide increased comfort in the early post-operative and post-radiation period.²¹ In a study by Coltman et al., the use of wide straps reduces discomfort and minimizes the pressure felt on the shoulder.²¹ In a qualitative study by Liu et al., breast cancer survivors described how their experiences and preferences regarding bras evolved from pre-mastectomy through post-reconstruction.⁵ Five key themes emerged, highlighting challenges such as poor fit, discomfort from closures (particularly front hook-and-loop styles), and frustration with inadequate post-surgical garment guidance. Survivors expressed strong emotional associations with bra color and style, linking them to well-being, normalcy, and control. Despite clinical recommendations for specific bra types, many participants reported prolonged difficulties finding bras that accommodated their post-surgical anatomy, fluctuating body shape, and sensitivity. The study underscores the need for more customizable, adjustable options and better access to trained fitters to support survivors' long-term comfort and quality of life.⁵

A design feature that is being explored by modern bra designers is cup height, which can be defined as the maximal measurement from the base of the brassiere to the top. The use of a lower cup has been examined as it is associated with decreased arm pain and less contact with the surgical scar. Conversely, it has been reported that larger-chested women who wear brassieres with lower cup heights experience spillage.¹⁵ Again, this feature should be a consideration, but it is important to note the specific limitations.

Asymmetry is an important factor when considering the post-surgical bra. The bra is associated with a woman's self-image, and struggling to acquire a proper bra can lead to both physical and psychological distress.^{15, 27} To address breast asymmetries, weighted prostheses are often an ideal choice. Breast prostheses work by recreating the shape and the size of the missing breast to restore even weight distribution. The use of breast prostheses helps with the correction of posture while also improving women's self-esteem and self-confidence, improving the quality of life of many patients.¹¹

There are generally two types of breast prostheses that are utilized. The first type is a contact prosthesis, which possesses an adhesive side that can be applied directly to the chest wall. These prostheses do not require specialized undergarments. The second is a non-adhesive prosthetic where the prosthetic is placed into a pocket of the post-operative garment. This option is available for purchase directly or can be customized to provide a more accurate fitting.

These are important factors that have been considered when creating the post-surgical bra. Often, women are not well-informed with regard to the different options, and this leads to higher expenses as well as increased potential for pain and musculoskeletal problems. The lack of guidance and poor experience with ill-fitting garments may drive women who would benefit from prostheses to avoid the entire process.¹⁵ Conventional post-operative garments do not provide a proper fit to account for a prosthesis or the post-surgical breast.

Compression is an important consideration when creating a post-mastectomy garment, given its use in treating swelling and lymphedema, increasing mobility, and assisting with drainage to alleviate pressure.^{12, 15} On the other hand, high levels of compression can lead to patient discomfort and pressure on sensitive skin.¹⁵ The degree of compression is not well-defined in the literature, as many women have unique levels of comfort and tenderness.¹⁶ This, however, does create a demand for a post-operative garment that utilizes a customizable compressive feature to accommodate these qualitative differences. The OptiBra randomized controlled trial by Backman et al. evaluated 201 breast cancer patients undergoing various types of primary surgery and compared outcomes between a soft bra (SB) and a stable bra with compression (SBwC) over a 3-week post-operative period.⁶ While no significant difference in overall pain scores was seen across the entire cohort, a subgroup analysis revealed that among patients still experiencing pain at 3 weeks, those wearing the SBwC had significantly lower pain scores (P = 0.018). The SBwC group also reported improved arm mobility (P = 0.031), greater comfort (P = 0.027), and a stronger sense of support and security during daily activities (P = 0.032). These findings suggest that stable compression bras may facilitate early mobilization, reduce the risk of persistent postsurgical pain, and contribute meaningfully to recovery and quality of life following breast cancer surgery.

The standard of care for a woman receiving breast-conserving surgery is to undergo adjuvant radiation. Cardiac and pulmonary complications associated with radiation are limited due to the use of 3D radiation treatment planning.¹⁸ Some patients with physiologic and anatomical differences develop adverse reactions despite these advancements.¹⁸ A study by Piroth et al.¹⁸ showed that by using a thermoplastic breast bra, radiation doses to the heart and lungs were lowered without additional skin toxicity. Another study by Keller et al. reconfirmed that the use of a bra reduced chest wall separation and heart volume within the treatment field.²⁶ A post-surgical garment that implements this science may also limit adverse complications associated with radiation and lead to improved patient outcomes.

There are still many gaps in the literature that need to be addressed. Firstly, the primary methodology used to obtain pertinent data across the reviewed studies was questionnaires. While the use of questionnaires and surveys is an effective way to obtain qualitative information, it does not allow the collection of empirical evidence and clear quantitative data. Secondly, while the improvement in the manufacturing and design of post-operative garments resonates throughout all these studies, the actual advancements that need to be implemented are unclear, and most suggestions are opinion-based. For example, qualitative surveys have demonstrated a need for post-operative garments with softer materials.¹⁶ However, there are limited data to delineate exactly what material is preferred. Thirdly, current evidence has advocated for improvements, but the proposed changes have not yet been studied. It is unclear if any of the prospective designs will lead to improved patient satisfaction. Further studies are required to better answer these questions.

This review has several limitations. First, the included studies exhibited substantial heterogeneity in terms of design, populations, interventions, and outcomes, which limited direct comparisons and precluded formal meta-analysis. Second, many of the studies had small sample sizes, reducing generalizability and statistical power. Third, a significant proportion of the literature relied on subjective, patient-reported outcomes without standardized measurement tools, introducing potential reporting bias. Additionally, few studies reported long-term follow-up data, limiting insights into sustained outcomes beyond the immediate post-operative period.

Another limitation is the geographic and cultural skew of the data. Most studies originated from high-income countries, with underrepresentation of perspectives from low- and middle-income settings, where access to customized post-surgical undergarments and prostheses may be more limited. Furthermore, the review focused primarily on cisgender women, and findings may not fully capture the needs of gender-diverse populations undergoing chest surgery.

Finally, although an updated literature search was conducted through April 30, 2025, publication lag may have excluded emerging studies currently in press, and non-English articles were not included, which may introduce language bias.