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. 2016 Mar 8;8:39–45. doi: 10.2147/BCTT.S102598

Table S1.

Clothing restriction following breast surgery questionnaire (please rate your ability to do the following in the last week by circling the number by the appropriate response)

No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable
Wear a bra or prosthesis 1 2 3 4 5
Wear a bra or prosthesis all day 1 2 3 4 5
Tolerate some fabrics against your skin in affected area 1 2 3 4 5
Touch the scars from the mastectomy 1 2 3 4 5
Ability for someone else to touch the mastectomy site 1 2 3 4 5
Look at your scars from breast surgery 1 2 3 4 5
Feel less feminine since cancer 1 2 3 4 5
Tolerate people looking at you 1 2 3 4 5
Comments:______________________________________________________________