Post-operative complications can be reduced or even avoided through the use of compression garments. Eva Sanchez runs through the key features to consider when choosing garments for your patients
For many hospitals and private clinics, it has become standard practice to provide cosmetic surgery patients with appropriate compression garments immediately following their procedure. These specially-designed bras, girdles, vests and binders provide compression and support throughout the recovery period. For many plastic surgeons they are considered an essential part of post-surgery care.
However, there appears to be no real consensus among cosmetic surgery professionals on the use of compression wear. This is hardly surprising, since despite the plethora of information available through the publications and websites of manufacturers and suppliers, clinical research into the use of compression garments after aesthetic surgery procedures is somewhat limited.
Compression therapy is nothing new. It has long been considered the most effective treatment for lymphoedema and venous ulcers, and as a means of reducing swelling and oedema resulting from injuries such as sprains. Over 2,400 years ago, Hippocrates himself recommended the use of a double compress to treat varicose veins and ulcers of the leg.
While the principle of modern compression therapy is very similar to this ancient practice, the method for applying it has evolved. Since modern liposuction techniques were first initiated by Arpad and Giorgio Fischer in the mid-1970’s, and further developed by Yves-Gérard Illouz and Pierre Fournier, compression therapy has become an integral aspect of post-liposuction care.
However, the therapeutic benefits of external pressure on affected areas following surgery are not restricted to liposuction—they are applicable to a range of procedures. Specialised area-specific garments have been developed for breast surgery, abdominoplasty, brachioplasty, face lifts and gynaecomastia surgery in men.
From the perspective of plastic surgeons, the main purpose of wearing compression garments is to alleviate the more common post-operative complications resulting from trauma to subcutaneous layers of the skin, particularly bruising and oedema.
The external pressure provided by an appropriately-fitted garment mitigates bruising by restricting bleeding from capillaries and promotes the drainage of tissue fluids from the affected area by elevating the interstitial hydrostatic pressure in the deeper layers of the skin. Compression garments are also thought to control the occurrence of haematomas and seromas after surgery, and promote patient recovery from these complications.
There is also evidence to suggest that post-operative compression therapy can reduce the incidence of hypertrophic or keloid scar formation, particularly when applied in conjunction with silicone gel. Although there is medical research demonstrating the efficacy of this method of treatment, the mechanism is not yet fully understood.
In terms of the overall aesthetic results achieved with cosmetic surgery, there is fairly widespread agreement amongst surgeons that compression garments provide some benefits. It is thought that they promote and guide the natural retraction of the skin and formation of fibrous connective tissue, while reducing the risk of unwelcome fibroses, folds and creases.
Since cosmetic surgery patients are ultimately concerned with their eventual appearance after their procedure, these potential advantages are likely to be of particular interest to them. However, it is essential that prospective patients discuss the likely results with their surgeon before a procedure to ensure that they have realistic expectations of both the surgery and the healing process.
One aspect of compression garments that patients typically report is that it helps to relieve post-operative pain, particularly in the initial stages of recovery. This effect seems to be related to the immobilisation and support of the skin and underlying tissues, as patients often notice an increased level of discomfort after removing their garment for bathing.
The pain management function of compression garments may improve patient compliance with this form of treatment. This means they can benefit from the other practical benefits of compression garment wear, such as their role as a physical barrier to wound site infection and as a means of holding absorbent pads in place.
While compression garments offer a variety of potential benefits for recovery, it is crucial that patients follow the the advice of their surgeon to maximise the advantages. To some extent, compression therapy can be tailored to the individual; specifically the type of garment worn, area of coverage, strength of compression and period of wear.
Surgeons differ in their opinions regarding the most effective application of garments and recommendations to patients vary depending on the procedure undertaken, expected rate of recovery and any anticipated complications. However, despite variability in prescribed regimes—ranging from as little as two weeks to as long as three months—it is generally accepted that the initial two to three weeks post-surgery are the most significant.
The features many surgeons look for in a compression garment are coverage, firm compression, convenience, comfort and durability. Adapting the coverage of a garment to suit the patient and the procedure they have undertaken should be relatively easy to accomplish.
There is a wide range of specialised garments available, with the option of providing general cover over the whole section of the body, or targeting the cover to a specific area only—for example, a body suit versus an abdominal binder.
In terms of compression, it is generally agreed that the pressure should be comfortably firm without being too constrictive. To be effective, a garment needs to provide sufficient compression to mitigate bruising and oedema. However, it is important that it does not over-compress the tissues, as this can have the counter-productive effect of restricting the flow of lymph and potentially result in oedema in surrounding areas.
It is also advantageous if the pressure over the affected area is evenly distributed, which is more likely with four-way-stretch fabrics, which stretch and compress lengthwise and crosswise.
Convenience is also important. It is important that theatre staff can dress the patient with the garment and, subsequently, that the patient can dress themselves without placing undue strain on the skin. This is made easier with front-mounted fastenings and hook-and-eye closures, which have the added benefit of being adjustable to account for fluctuations in size from swelling and contraction.
Since it is usually recommended that compression garments are worn continuously and only removed for bathing or changing, they will also ideally have an open crotch design to allow patients to use the toilet with ease.
Considering the demanding regime expected of patients with post-surgery compression, comfort should be prioritised when selecting suitable garments. If a patient is comfortable when wearing their garment, it increases the likelihood that they will comply with the treatment, potentially mitigating complications.
Patient comfort tends to be influenced by a number of different factors, not least their subjective tolerance of wearing tight garments for long periods of time after painful surgery. Nevertheless, we have come a long way since the elastic wraps, or “French tape”, of the late 70’s and early 80’s. Modern garments can be very comfortable, with many patients even opting to wear them beyond their recovery phase.
Patients tend to appreciate the softness of their garment and its elasticity. Ideally a compression garment will feel smooth against the skin, with no irritation and will move and flex with the body with normal activity, preventing undue friction or creasing that can result in uneven pressure and localised soreness. A well-fitted compression garment should feel like a “second skin”.
Durability of compression wear is an essential feature, as it will be worn continuously by patients while they go about their daily activities for a number of weeks, or potentially months. To ensure that they continue to deliver firm and consistent external pressure, compression garments need to retain their elasticity and structural integrity throughout long periods of wear and numerous wash cycles.
Some medical-grade garment manufacturers conduct regular quality control testing on their fabrics to ensure that they retain their strength and elasticity after being stretched and washed repeatedly, which helps to maintain the effectiveness of the products.
Firm and consistent compression
Soft, breathable, ‘four-way-stretch’ fabrics
Durable construction for continuous wear
Flat seams and wide shoulder straps
Front or side-mounted fastenings
Adjustable fastenings to account for swelling
Good, comfortable fit (‘second skin’)
Reasonable freedom of movement
Ineffectual or excessive compression
Abrasive fabrics that irritate sensitive skin
Potential allergens such as latex
Metal stays that can cause irritation
Rear fastenings that are hard to reach
Unprotected fastenings that could snag skin
Folds in the garment when worn
Poor flexibility and friction during movement
Considering these key features, it is not as simple as it might initially seem to choose an appropriate compression garment for patient recovery. Choosing garments for each patient is often a duty performed by clinic staff on behalf of the surgeon. However, in some instances, the patients themselves purchase them directly from suppliers, often with some degree of guidance. Considering the wide range of manufacturers and garments aimed at a variety of surgical procedures, the choice can be bewildering. In particular, it is not always clear to patients what the differences are between medical-grade garments and conventional sports or slimming compression wear.
Specialised post-surgery garments differ from sports compression in a number of ways. Most notably, they should provide stronger and more durable compression because of the properties of the fabrics used and the specialised construction of the garments. Post-operative garments are designed to be worn continuously for as long as two to three months. Sports compression wear simply isn’t designed for such intensive use and could lose integrity if used for post-surgical recovery.
The fabrics used in medical-grade garments should offer a good balance of elasticity, usually provided by elastane—such as LYCRA—and tensile strength and durability, usually provided by polyamide, or nylon. Fabric composition varies between manufacturers and garment types, and tends to range between 10% and 55% elastane. The yarns, and the way in which they are woven, also varies from fabric to fabric and can alter the degree of stretch, compression and other key properties.
Fine yarns, such as nylon microfibre, can provide additional softness against the skin. In addition to the nature of the fabric, the construction of medical-grade garments is also an important differentiation. They should be manufactured in a way that minimises irritation against the skin and especially against surgical wounds. Therefore, garments should have flat seams, and bras and girdles should have wide shoulder straps and no metal stays. They should also be completely free of any potential allergens such as latex.
There is a lot to consider when choosing compression wear for each patient, but it doesn’t end at the selection of a suitable garment. The fit of a garment to the patient is a critical detail which can have significant effects on the outcome of the post-operative recovery and on patient comfort and support.
A poorly-fitting compression garment that is too loose, too tight or that has an uneven distribution of pressure can result in unnecessary discomfort and could have a negative impact on the overall outcome of the procedure. Therefore, it is an essential aspect of surgery preparations to ensure that the patient is correctly measured for their garment using the manufacturer’s sizing system.
For patients with atypical body shapes and sizes, such as very tall individuals or those with a large bust for their size, it is more effective to wear two separate garments of different sizes than to cover the affected areas with one ill-fitting garment or to order custom-made garments. Patients typically wear their garments constantly, so it is usually advisable for them to have at least two to allow them to change regularly to maintain personal hygiene, particularly if there is drainage from surgical wounds.
For many patients it is possible to switch to less intensive, “second-stage” garments, around two to three weeks after surgery. These differ from “first-stage” compression garments in that they are usually pull-on, without any fastenings, and tend to be more discreet under clothing. This makes them more comfortable for patients to wear continuously and, in some cases, second-stage garments are worn for longer than is strictly required for recovery, simply because patients appreciate the additional support they provide.
Selecting the right post-surgery garment can be more of a challenge than one might expect but, with due care and consideration, the eventual choice has the potential for promoting a smooth and complication-free recovery for each patient.
For this reason, it is prudent to begin preparing for post-surgery recovery, including choosing suitable compression garments, in tandem with planning for the procedure itself. The extra effort involved is likely to yield rewards in the form of improved patient comfort and well-being and even the overall outcome of the surgery.
Eva Sanchez is the founder and managing director of Recova Post-Surgery, which is based in London W: recovapostsurgery.com
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