Chest binding tips and risks

“Binding” is a term you may have heard lately in discussions about gender identity. Chest, or breast, binding is a common practice among transgender males — people assigned the female sex at birth who identify as male — and nonbinary people — also known as genderqueer, a spectrum of gender identities not exclusively masculine or feminine — who wish to express themselves in a more masculine way by compressing the chest tissue.

The benefits of binding
“Breast binding refers to various methods used to flatten breast tissue and create a flatter-looking chest,” says Nancy Jungling, a physical therapist with Sharp Rees-Stealy Medical Centers. “For some, breast binding is an alternative to invasive female-to-male and female-to-neutrois, or nonbinary, also known as FTM/N, chest surgery.”
Additional benefits of chest binding for transgender and nonbinary people were recently noted in a study published in the medical journal Culture, Health & Sexuality. These include:

• Improvements in mood

• Increased self-esteem

• Minimized gender dysphoria — a conflict between a person’s physical gender and the gender with which they identify

• Decreased anxiety and depression

• Improved sense of autonomous control of the body

• Increased comfort in one’s body

• Improved perception of one’s preferred gender by others

Health risks related to binding
However, Jungling noted that chest binding has significant health risks. “In extreme cases, breast tissue can become permanently damaged,” she says. “Strong, prolonged pressure around the chest and back can also cause changes to normal spine alignment, which may result in chronic pain.”
More common risks associated with binding include:

• General aches and pains

• Altered rib cage

• Breathing restriction

• Overheating

• Circulation compromise

• Nerve compression

• Bruising and scarring

• Itching or other skin irritation

Tips for safe breast binding
According to Jungling, there are many methods that can reduce the appearance of breast tissue. Effectiveness depends on the size of the breasts and overall body type.
Common methods include:

• Layering shirts

• Sports bras

• Compression exercise shirts

• Top portion of control-top pantyhose

• Commercial binders

“Choose the least restrictive method that still achieves the desired results, and always remember to give your body a break as frequently as possible to relieve the aches and pains associated with regular binding,” Jungling says. “A physical therapist can help prescribe appropriate stretches for this rest period to minimize secondary irritations.”
Experts also stress that you should never use plastic wrap, duct tape or elastic bandages to bind your chest. These materials can restrict your ability to breathe and move properly. Ace bandages are designed to constrict, so as you breathe, they get progressively tighter.
Other tips for safe and effective binding include:

• Always remove your binding before you sleep

• Do not wear binding while exercising

• Remove binding before showering

• Never wear binding for more than eight hours at a time

• Take days off from wearing binding when possible

• Never layer commercial binders

• Do not wear too-small commercial binders

Parents with preteens and teens practicing breast binding should pay special attention to the method and materials being used and talk to them about the inherent dangers of binding, especially with developing breasts, as permanent tissue damage is possible. The American Academy of Pediatrics recommends parents talk to their child’s pediatrician about gender-affirmative, developmentally appropriate care oriented toward understanding and appreciating your child’s gender experience.
“As a general rule, pain is an indicator that something is wrong, and one should seek professional care,” Jungling says. “It is important to consider mental health and quality of life when prescribing treatment plans. If the treatment is causing physical stress or anxiety, it should be modified to be most effective. Flexibility and communication are cornerstones for quality care.”

Talk with your doctor if you or your child have experienced pain or other negative side effects related to chest binding. Sharp Rees-Stealy is proud to offer gender-affirming care.