Article written by RECOVA® founder, Eva Sanchez, on the key features to look out for when choosing a compression garment. Featured in the 'Body Language' Journal of Medical Aesthetics

Compression Garments: A Key Consideration for Cosmetic Surgery Recovery?

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, and for many plastic surgeons they are considered an essential part of post-surgery care. However, there appears to be no real consensus on the use of compression wear amongst cosmetic surgery professionals. This is hardly surprising, since despite the plethora of information available through the publications and websites of manufacturers and suppliers, it seems fair to say that clinical research into the use of compression garments after different plastic surgery procedures is somewhat limited.

Of course, 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 due to injuries such as sprains. Indeed over 2,400 years ago, Hippocrates himself recommended the use of a double compress to treat varicose veins and ulcers of the leg. Although the principle of modern compression therapy is very similar to this ancient practice, the method for applying it has evolved somewhat. 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 in the following years, compression therapy has been 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 wide range of different procedures, and 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 some of the more common post-operative complications resulting from trauma to subcutaneous layers of the skin, particularly bruising and oedema. 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 the 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 clearly 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 garment wear that patients typically report is that it helps to relieve post-operative pain, particularly in the initial stages of recovery. This effect seems likely to be due to the immobilisation and support of the skin and underlying tissues since 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, which means they can benefit from the other practical benefits of compression garment wear, including their role as a physical barrier to infection of wound sites and as a means of holding absorbent pads in place.

While compression garments offer a variety of potential benefits with respect to recovery, in order for patients to maximise the advantages, it is absolutely crucial that they follow the the advice of their surgeon. To some extent compression therapy can be tailored to the individual in terms of 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 tend to vary depending on the specific procedure undertaken, expected rate of recovery and any anticipated complications. However, despite considerable 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.

From the perspective of many surgeons the key features that they 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 surgery 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 (e.g. body suit vs. abdominal binder). In terms of compression, it is generally agreed that the pressure should be comfortably firm without being too constrictive. There are a number of reasons for this, some medical and others relating to patient comfort and compliance. In order 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, since 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.

With regard to convenience, from the first instance 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 or side-mounted fastenings and hook-and-eye closures, which have the added benefit of being adjustable to account for fluctuations in size due to swelling and contraction. In addition, since it is usually recommended that compression garments are worn continuously, and only removed for bathing or changing, they will ideally have an open crotch design to allow patients to use the toilet with ease.

Considering the demanding regime expected of patients with regard to post-surgery compression, comfort should certainly 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 indeed, with many patients even opting to wear them beyond their recovery phase. From the perspective of patients, it tends to be the softness of their garment and its elasticity that are the key attributes they appreciate the most. 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’, and in order to achieve such high levels of comfort, a high quality modern medical-grade product should be sought.

Durability of compression wear is an essential feature, since it is to be worn continuously by patients while they go about their daily activities for a number of weeks, potentially months. In order 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.

Considering all of these key features, one can say that 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, but not in every case. Considering the wide range of manufacturers and different 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 due to 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 potentially 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 (e.g. LYCRA), and tensile strength and durability, usually provided by polyamide (nylon). The composition of the fabrics varies somewhat between manufacturers, and specific garment types, and tends to range between around 10% and 55% elastane. The yarns and the way in which they are woven also varies from fabric to fabric, which can alter the degree of stretch, compression and other key properties. For instance, fine yarns, such as nylon microfiber can provide additional softness against the skin. Also, to improve comfort, the fabric should be breathable and wick moisture from the skin. In addition to the nature of the fabric, the construction of medical-grade garments is also an important differentiation. For instance, 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.

Clearly there is a lot to consider with regard to 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 an absolutely critical detail which could have significant effects on the outcome of the post-operative recovery, and certainly on patient comfort and support. A poorly fitting compression garment, that is either too loose, too tight or that has highly uneven distribution of pressure, can result in unnecessary discomfort and possibly 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 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. Bearing in mind that patients typically wear their garments constantly, 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 tends to make 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 initially suppose, 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 possibly even the overall outcome of the surgery.

Eva Sanchez is the founder and managing director of Recova Post-Surgery based in London (www.recovapostsurgery.com).

REFERENCES

1. Partsch H, Flour M, Smith PC, International Compression Club. “Indications for Compression Therapy in Venous and Lymphatic Disease Consensus Based on Experimental Data and Scientific Evidence. Under the Auspices of the IUP.” Int Angiol 2008 Jun; 27(3): 193-219.
2. Warren AG, Brorson H, Borud LJ, Slavin SA. “Lymphedema: A Comprehensive Review”. Ann Plast Surg 2007; 59: 464-472.
3. Brorson H, Ohlin K, Olsson G, Svensson B, Svensson H. “Controlled Compression and Liposuction Treatment for Lower Extremity Lymphedema”. Lymphology. 2008; 41: 52-63.
4. Royle J, Somjen GM. “Varicose Veins: Hippocrates to Jerry Moore”. ANZ J Surg 2007; 77: 1120-1127.

For more general information on compression garments please read the following article in the journal of medical aesthetics Body Language written by RECOVA® founder, Eva Sanchez: http://www.bodylanguage.net/compression-garments/