QualiBra Advanced FAQ's

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Generally about QualiBra Advanced:

  1. What is QualiBra Advanced?
    QualiBra Advanced is a multi-functional external sternum and thorax support combined with a brassiere, and is designed for fuller-sized women who have had a sternotomy procedure. It consists of a purpose-designed brassiere that has adjustable vertical bands on each side of the breasts, adjustable shoulder straps, double front closures, and it has an adjustable, chest circumferential, elastic sternum band attached to it.

  2. What does multifunctional mean?
    That QualiBra Advanced functions in several ways. 1. it gives a constant, lateral support on the sternum by the firm, circumferential thorax band, 2. it has integrated pockets in the band to be used by the patient to obtain additional circumferential tension for cough and sneeze support, 3. it has central vertical bands to keep the sternal wound free from breast tissue, 4. it has lateral vertical bands to prevent weight pull on the sternal wound, and 5. double front closures allow for wound care and inspection with just one of the closures open thereby maintaining breast support and preserving the woman’s dignity.

  3. Who should use QualiBra Advanced?
    QualiBra Advanced is for women with a breast size requiring a bra cup size C or higher, and it is strongly recommended for all patients at high risk for postoperative complications e.g. obesity, diabetes, preoperative renal failure, previous myocardial infarction, osteoporosis, age, chronic obstructive pulmonary disease (COPD), chronic cough, and current smokers [26,46,59]

  4. Is QualiBra Advanced only for sternotomy patients ?
    No, it is for all women with a breast size requiring a bra cup size C or higher, who experience breathing discomfort and pain, e.g. thoracotomy and chest trauma patients.

  5. Has QualiBra Advanced been clinically proven?
    The integrated sternal support in QualiBra Advanced is a “mini-QualiBreath”, and QualiBreath is the only external chest support that has been evaluated for a broad range of important criteria for improving postoperative recovery. It was shown to significantly decrease pain and sternal separation in patients with chronic sternal instability, and it had a positive effect on patient function, comfort, ease of breathing, and ease of exercise activities. [80] Other evaluations of various external chest supports have shown that a firm external complementary support to the internal sternal closure significantly decrease sternal wound infections. [75,78-84,86]
     

What QualiBra Advanced does for the patient:

  1. What can QualiBra Advanced do?
    It gives a constant lateral support on the sternum from the external side which complements the internal sternal closure and helps patients to manage breathing and pain after sternotomy surgeries. Furthermore the purpose-designed bra gently separates the breasts to keep the sternal wound free of breast tissue, and it supports the weight of breast tissue to prevent gravitation to the lateral sides.

  2. Why do fuller-sized women need a purpose-designed bra after a sternotomy?
    Women with larger breast tissue are exposed to additional issues postoperatively due to the weight of breast tissue which causes a constant pull on the sternotomy wound. Such pull may lead to wound rupture, wound infection, wound healing deformation and other complications after surgery. [44,46,76]

  3. Why should the breasts be “separated” after a sternotomy?
    Keeping the breast tissue gently away from the sternal wound without pulling, helps to keep the wound area dry and free from heat and moisture build-up thereby decreasing potential wound infections. It also promotes a more aesthetic wound healing in a very visible position which is important for women of all ages.

  4. Is lateral support on the sternum necessary?
    Yes. The two sternum halves are held together by wires or plates after a sternotomy, which are the only force to withstand a concurrent strain of the sternum in lateral direction. Complementing the internal sternal closure by an external lateral support on the sternum from the outside has been shown to be highly effective and to significantly decrease sternal complications. [75,78-84,86]

  5. Can QualiBra Advanced give a firm sternum support when it is elastic?
    Yes. The specially selected elastic material is unidirectional and has a precisely monitored elasticity of 100% (+-10%). This results in a firm, yet comfortable support all around the thorax. The controlled elasticity combined with the correct sizing and adjustable closure provides a firm circumferential thorax support without jeopardising comfort.

  6. Does QualiBra Advanced restrict breathing?
    No. The QualiBra Advanced sternal band is designed with a calculated height of material and rests above the breasts so the lower lung lobes and the upper abdominal area are not covered at all. The result is that the sternum, the thoracic wall and respiratory muscles are supported, which encourage deeper breathing and engagement of the diaphragm.

  7. Can QualiBra Advanced relieve pain?
    Yes. The firm, unidirectional, elastic support to the ribs and respiratory muscles during inspiration relieves pain and assists the patients to achieve a more relaxed, deeper breathing.

  8. How can QualiBra Advanced assist during coughing or sneezing?

    Thanks to the integrated pockets placed on each side of the sternum in the chest band, the patient can easily insert the thumbs or 4 fingers in each pocket and bring them together. This action will reinforce the circumferential thorax support, counteract the increased internal thoracic pressure during coughing or sneezing thus relieve pain and protect the sternum.

  9. Does QualiBra Advanced have any psychological effects?
    Yes. The constant support of the breast tissue and on the thorax gives patients a feeling of being held firmly together thus reducing anxiety about potential harm to the sternal wound from breast weight pull, coughing, sneezing or breathing exercises. QualiBra Advanced is a constant “reminder” for patients to protect their sternum, and the pockets assist them to regain independence and confidence in their ability to manage themselves anytime without the need for help from hospital personnel.

  10. Why is it important to use QualiBra Advanced immediately after surgery?
    The external complementary reinforcement of the internal sternal closure helps to protect the sternum right from the start, as well as the immediate support of breast tissue relieves pain and protects the sternal wound from suture line rupture due to breast weight pull.

How to measure the correct size:

  1. Does the QualiBra Advanced sizes correspond to off-the shelf bra sizes?
    Roughly speaking, yes. Unfortunately there is no standard sizing for off-the-shelf bras and bra size labeling systems vary from country to country. In addition, manufacturers do not adhere to international standards. Most countries use alphabetical letters to identify the cup size, however a bra cup size may vary even if the letter is the same. The sizing chart we use for QualiBra Advanced was developed after studying the various size labelling systems worldwide with the aim of being as close to the average between all country variations as possible.

  2. How is it possible to know which QualiBra Advanced size to choose?
    The patient’s chest and breast size must be measured and the corresponding QualiBra Advanced size located on the sizing guide which is included on all brochures, posters and here.

  3. What do the QualiBra Advanced sizing codes mean?
    The sizing codes are a reference to the under-bust size in cm and the bra cup size identified by an alphabetical letter, e.g. 95E means an under-bust size of 95 cm and a bra cup size E.

  4. How is the QualiBra Advanced sizing chart used?
    Two measures are needed: the chest circumference directly underneath the bust and at the fullest point on the bust. When knowing these two measures the correct QualiBra Advanced size can be selected on the QualiBra Advanced sizing chart.

  5. What is the correct method for measuring the fullest bust size?
    The circumference on the fullest bust must be taken when the patient is in a standing or sitting position and the bust is supported by her normal bra. If no bra is available or being used, the woman should be asked to support her breasts with her hands during measurement to avoid a wrong measurement on a sagging bust.

  6. When are the measurements taken for the QualiBra Advanced?
    Ideally the measurements for the QualiBra Advanced should be taken in the admission department before surgery and the QualiBra Advanced size should be clearly noted in the patients journal. Measuring the patient before surgery facilitates selecting the correct size which should follow the patient to the O.R.

  7. What does the pink colour on the QualiBra Advanced sizing chart mean?
    The sizes highlighted in pink on our chart are the most commonly used sizes.

  8. What if the measurements are “out-sizing” the QualiBra Advanced chart?
    In that case we need to know the two measurements (under-bust and fullest bust) to identify the correct bra-cup size. The QualiBra Advanced poster shows a bra-cup size “identifier” along with the normal sizing chart, where the difference between the under-bust and fullest-bust measurements can be matched to the alphabetical letter for the bra-cup size.

  9. Is there a way to chose a QualiBra Advanced size if no measure tape is at hand?
    Yes, a rough way is to use one’s hands to measure the patient’s thorax from one side to the other underneath the breasts. An outspread hand-width from thumb to little-finger is roughly 20 cm or 8 inches e.g. if the measure is found to be 2.5 hand-widths, the circumference would be 5 hand- widths, or 100 cm (40 inches). The correct under-bust size is then identified on the sizing chart. The bra cup size can roughly be estimated by asking the normal bra cup size the patients uses. If this information is not available, estimate the patient’s normal clothing size, e.g. Small, Medium etc. and check on the QualiBra Advanced poster for the corresponding bra-cup size.

How to use QualiBra Advanced:

  1. When should QualiBra Advanced be applied?
    In the operating room immediately after surgery by placing it on the bed before the patient is transferred. Using this practice is undemanding for staff and less challenging for the patient.

  2. How does QualiBra Advanced work?
    QualiBra Advanced has integrated central and lateral breast aligners that individually can be adjusted to position the breast tissue in relation to the sternal wound. This will keep the sternal wound free of breast tissue and prevent gravitation to the lateral sides. Furthermore the amply wide shoulder straps can be adjusted to give the correct lift of the bust.

  3. What are the central breast aligners for?
    The central breast aligners keep the sternal wound free of breast tissue thereby promoting a healthier and more aesthetic wound healing, as well as it prevents heat and moisture generation which decreases the potential for wound infection.

  4. What are the lateral breast aligners for?
    The purpose of the lateral breast aligners is to prevent gravitation of breast tissue to the sides, so the weight does not pull on or rupture a the sternal wound between the breasts.

  5. Can the central and lateral breast aligners be adjusted?
    Yes, all 4 aligners are adjustable with Velcro closures in the triple adjusters right above the bra cups and can easily be tightened or loosened individually to meet the patient’s need for comfort, and the clinically required breast position for optimal results.

  6. What is the QualiBra Advanced triple adjuster?
    The unique triple adjuster is a special device with 3 bra adjusters arranged in a triangular fashion. A triple bra adjuster is positioned above each bra cup and allows for individual Velcro settings of the central and lateral bra aligners as well as the shoulder straps.

  7. How is QualiBra Advanced closed?
    All closures are at the front, both for the shoulder straps, the brassiere and the sternal support band which enhances comfort and ease of wound care. There are 2 Velcro mid-front closures of QualiBra Advanced: First the wide under-bust band is closed, second the shoulder straps , third the upper mid-front Velcro closure, and last the sternal support band.

  8. Are the closures and adjustments on QualiBra Advanced time consuming?
    No, not at all. QualiBra Advanced is supplied with all 4 breast-aligners pre-closed in the triple bra adjusters. All that needs to be done to position QUALIBRA Advanced on a patient is to close the two mid-front closures, the two shoulder straps and lastly the sternum support band. The four breast-aligner bands can be “fine-tuned” to a perfect fit later if needed.

  9. Why is QualiBra Advanced closed at the front?
    A front closure is more comfortable for a newly operated patient and is easier to open for wound inspection and care. It also makes it much easier and quicker for staff to open in emergency situations where quick access to the chest might be needed.

  10. Why does QualiBra Advanced have 2 front closures?
    The double front closure gives numerous advantages for wound care and comfort both for patient and staff. When wound care is needed, it is usually enough to open the upper front closure and the sternal band while the under-bust band remains closed. Breast support is thus maintained during wound care and the patient experiences less pain. Maintaining the under-bust band closed also makes it much easier and quicker to close the brassiere and sternal band after wound care. In addition many women appreciate to have their breasts covered during care when possible.

  11. There is an opening between the 2 bra front closures, why?
    The “inspection zone” between the 2 mid-front closures makes it possible to inspect the dressing and/or wound without any need to open the QualiBra Advanced. Less opening of the bra means less strain on the wound from the weight of breast tissue, which means less pain for the patient.

  12. Why is the under-bust band wider than normal brassieres?
    The under-bust band is wide to maximise comfort and fitting. It also prevents that the materials crawl up underneath the breast tissue which is a problem with many brassieres.

  13. How can drainage tubes be accommodated with QualiBra Advanced?
    Normally the drainage tubes will exit underneath the elastic under-bust band without any difficulties. Depending on a woman’s build and figure, it may be advantageous to let the drains exit above the under-bust band between the 2 mid-front closures.

  14. Why are the bra cups made of satin?
    The soft satin stretches very little in only one direction. Each bra cup consists of 2 special shaped unidirectional satin pieces which are arranged so the material itself helps to prevent gravitation to the sides and supports the uplift. The result is a soft, comfortable, yet firm breast support and lift of the tissue without compression.

  15. Why are the QualiBra Advanced satin cups double-layered?
    For comfort since it means there are no seams against the woman’s skin to cause irritation.

  16. Why are the shoulder straps crossed at the back?
    To give a good, comfortable fit of the brassiere and to give optimal support over the shoulders for the uplift of breast tissue. The brassiere does not have other material than the shoulder straps and under-bust band at the back side, which means it is extremely light and is not warm to wear.

  17. Why are the shoulder straps wider than normal brassieres?
    The QualiBra Advanced shoulder straps are wide, and get wider with the larger sizes, to prevent digging into the shoulders and to heighten comfort for the larger sized women.

  18. Is the QualiBra Advanced one-size-fits-all?
    No, a correct size must be chosen. The better the fit, the more efficient and higher comfort for the patient.

  19. What is the correct position of the QualiBra Advanced sternum band?
    The QualiBra Advanced sternal band must be positioned as high as possible above the breasts.

  20. Why is there no underarm shaping on the QualiBra Advanced sternum band?
    Because cutting out an area in the sternum band under the armpits would eliminate the important circumferential tension efficiency and the lateral support of the sternum in an area corresponding to the depth of an underarm shaping.

  21. What to do if patients feel QualiBra Advanced bothers them under the arms?
    This may happen specially when patients are bedridden more than expected which can cause the QualiBra Advanced band to be pushed up at the back side and thereby in the armpits too. The under-bust band can be readjusted for a lower position of QualiBra Advanced at the back side. If this is not enough, use the Axillapad perspiration pads accessory to protect the armpits.

  22. Can the patient position the QualiBra Advanced on their own?
    Not immediately after surgery. QualiBra Advanced should initially be applied by a health care professional in the OR or the ICU. When patients are mobile and know the correct movements for protection of the sternum, they can easily position QualiBra Advanced without help.

  23. How does the QualiBra Advanced pockets work?
    The pockets should be used by both hands while the upper arms are kept close to the chest. The patient places each thumb or 4 fingers under the material fold that forms a pocket on both sides of the sternum. She then brings the 2 hands together or on top of each other. This action will stretch the elastic sternal band, add extra circumferential support to the thorax and increase the lateral reinforcement on the sternum.

  24. When should patients use the QualiBra Advanced pockets?

    The pockets should be grasped for additional reinforcement during coughing and sneezing. It is also very much appreciated during deep breathing exercises or other painful situations. The sternum band should be firmly tightened on the upper part of thorax, so there normally is no need for a lot of extra force.

  25. Is the distance between the QualiBra Advanced pockets the same in all sizes?
    No, the distance between the pockets becomes proportionally larger, the larger the size.

  26. Should QualiBra Advanced be used during the day or at night only?
    It should be used both day and night until the sternum bone has healed, which means at least 8 weeks.

  27. How much should the QualiBra Advanced sternum band be tightened?
    Since QualiBra Advanced is placed on the patient immediately after surgery, often before she is fully awake after the anaesthesia, we recommend to start with a lighter closure at the first Velcro attachment on the band. When the patient is awake and cooperative, the band can be tightened more towards the most inner Velcro position to achieve a tighter support.

  28. Some patients perspire excessively. Does QualiBra Advanced increase perspiration?

    No. Normally not since the QualiBra Advanced sternum band material is ventilated. Patients with excessive perspiration under the armpits may want to use the accessory, AxillaPad perspiration pads which easily can be exchanged and washed as needed.

  29. Can the QualiBra Advanced cause irritation to the skin?
    Most unlikely. All seams as well as the manufacturer’s labels, are on the outside of the material facing away from the patient’s skin. Furthermore there are no buckles or other rigid items to cause pressure points on the skin.

  30. Can the QualiBra Advanced elastic material cause any allergic reaction?
    Most unlikely. The material is free of natural rubber latex (NO NRL) also called Latex-free.

  31. Is QualiBra Advanced washable?
    Yes. For longevity of the elastic material we recommend to wash it at 30°C without tumble drying.

  32. Should QualiBra Advanced only be used during the hospitalisation?
    No. QualiBra Advanced is a “one-per-patient” product and should follow the patient home.

  33. How can the pockets be used when QualiBra Advanced is worn under the clothes?
    The pockets are easily grasped through most lighter materials used for shirts, T-shirts or blouses. It is usually not necessary to wear an open shirt – QualiBra Advanced can be completely hidden and used discreetly under the patient’s clothes.

  34. For how long time should patients use QUALIBRA Advanced?
    They should use it till the sternum bone has properly healed, which means up to 8 weeks or more. They can use it for longer if they feel it helps them manage their breathing and any pain and that it supports their activities.

QualiBra Advanced and other devices:

    1. Is QualiBra Advanced a compression bra?
      No, it is a purpose-designed brassiere combined with an external sternum support that addresses the special needs fuller-sized women have after a sternotomy.
    2. Why is a compression bra not suitable after a sternotomy?
      Because compression bras constrain the breast tissue towards the thoracic wall which squeezes the central sternotomy wound between the breasts. This promotes the formation of heat and moisture on the wound, which is important to avoid since it “invites” bacterial growth and infection. In addition, a compression bra cannot prevent sagging of breast tissue to the lateral sides when a woman is in a horizontal position. Such weight pull directly on the sternal wound will further increase the risk of wound rupture and infection, wound healing deformation and other complications after surgery. [44,46,76]

    3. Can a sports bra be used as a post-operative garment?
      Sports brassieres and bras for athletic use aim at giving compression and to immobilize the breasts which allow women to perform sports activities in a comfortable and painless way. These devices are designed for sports activities, need usually to be pulled over the head, have no front closure, and do not meet the specific needs both patients and health care personnel have after surgery e.g. support and separate tissue, relieve pain, easy to apply, easy to open for wound care.

    4. What makes QualiBra Advanced different from other post-surgical bras?
      It has vertical, adjustable elastic bands on the central and lateral side of each breast which separates, gives support and lift to the breast tissue without compression. This is contrary to other post-surgical bras that are compression bras or simply dressing “holders” produced for other surgeries than a sternotomy. In addition, QualiBra Advanced has integrated sternum and thorax support for protection of the sternum bone, which no other post-surgical bra has.

    5. Is using a pillow an alternative to QualiBra Advanced?
      No. A pillow can not constantly support the sternum. Traditionally patients have often been advised to press a pillow against the sternum when coughing or sneezing. However, pressing a pillow or any other device directly inward on a fresh sternum wound and bone can do more harm than good, and may be a source of infection since pillows often fall on the floor or get in contact with other potential infection sources. Furthermore, pressing a pillow between large breasts may put s!train on the suture line increasing the risk of rupture.
      Read more about the pillow here.