Is body armour wear associated with breast discomfort and breast injuries among Australian Army female soldiers?

Purpose: Anecdotal evidence suggests that female soldiers may be experiencing breast discomfort when wearing the Tiered Body Armour System (TBAS). However, no research has been conducted to confirm this notion. The purpose of the current study was to determine the prevalence of breast discomfort and breast injury among female soldiers as a result of TBAS wear. Methods: A custom questionnaire was completed by 147 Australian female soldiers. The 59-item questionnaire included items pertaining to fit and function of TBAS, self-reported bra size, experience of breast discomfort (breast/chest compression and exercise-induced breast discomfort (EIBD)) and prevalence of breast injuries when wearing TBAS. Responses to questions were coded and counted. Participants were divided into two groups (Small breasts and Medium-Large breasts) based on bra size. Chi squared tests determined whether participants with Medium-Large breasts were more likely to report unacceptable levels of breast/chest compression, EIBD or breast injury when wearing TBAS (p < 0.05, SPSS v23, USA). Results: A high prevalence of breast discomfort (breast/chest compression: 75%; EIBD: 49%) was reported, attributed to a lack of space for breasts, as well as ballistic plates pressing into the breasts. Thirty-one percent of participants reported experiencing at least one breast injury when wearing TBAS, with bruising and abrasions the most common types. Injuries were attributed to long periods of wear and impact. Thirty-three percent of participants who reported a breast injury, reported the injury affected soldiering performance (decreased ability to perform tasks, altered technique or experience of discomfort/irritation). Compared to participants with Small breasts, participants with Medium-Large breasts were significantly less likely to rate the breast compression experienced as “acceptable” (χ2 (1, n = 147) = 6.583, p = 0.01), were significantly more likely to report experiencing EIBD (χ2 (1, n = 147) = 12.784, p < 0.001), as well as incurring a breast injury when wearing body armour (χ2 (1, n = 147) = 6.216, p = 0.013). Conclusion: Female soldiers are experiencing breast discomfort and injuries when wearing TBAS and report this affects their soldiering performance. This is amplified in women with larger breast sizes. Breast injuries should be a risk management consideration for military forces. Design of body armour should consider features to minimise breast discomfort and injury. Operational relevance: In order to enhance female soldiering performance future body armour should investigate how best to incorporate female-specific design features, including features which cater to the breasts.