During the Process of Breast Augmentation, following safety and cost, the discussion comes down to outcome; the most frequently asked question: “What size will I be?” Every potential breast surgery patient and plastic surgeon understands there is no standard bra cup size. However, preoperative and postoperative bra cup size remains the primary language used by most patients. This creates a significant conundrum for the patient and surgeon. Most patients have specific expectations regarding bra cup size, and achieving unmet real or unrealistic expectations remains the leading cause of patient dissatisfaction. In addition, implant size change remains the primary cause for reoperation exceeding actual surgical complications. The goal of this study is to standardize bra cup sizes based on the breast hemicircumference measurement alone along with patient reported bra cup size. This correlation method will also compare bra cup sizing between leading bra manufacturers in the United States and help create a uniform bra sizing language between surgeons and their patients.
Methods/Technique:
Documented measurements and reported bra cup sizes in 2894 breast augmentation patients, nearly 6000 breasts, were recorded prospectively with postoperative breast hemi-circumference measurements, bra cup size and specific bra manufacturer recorded. A subset within this general cohort of 420 primary augmentation patients was recorded separately and compared to the general database. No under bust or chest circumferences were taken into account, with breast hemi-circumference alone determining the patient’s cup size. In addition, the system has been confirmed in over 2000 additional breast patients measured. In 2008, 3-D imaging was initiated and utilized for the hemi-circumference measurements as a new method to confirm manual measurements recorded by the plastic surgeon. These validated measurements are easily integrated visually into the new bra cup measurement system. Average implant volumes used to achieve specific size changes, for instance from a reported A>C or B>C were also defined. Finally, five of the leading U.S. bra manufacturer measurement methods are compared to our standard bra cup sizing system, along with current measurement systems being used.
Results/Complications:
Data from a prospective database of over 2800 primary augmentation patients over an 11-year period was reviewed. Mean preoperative and postoperative breast hemi-circumference measured at 1 year was recorded by manufacturer along with reported bra cup size at one year. In addition 420 primary augmentation patients from one of the lead author’s cohort was collected and compared to this national database (Table 1).
| Cup Size | Overall Data | Bengtson Cohort |
| A Cup | 17.0 cm | 16.5 cm |
| B Cup | 18.9 cm | 19.0 cm |
| C Cup | 21.3 cm | 21.0 cm |
| D Cup | 23.5 cm | 23.5 cm |
| DD Cup | 25.5 cm | 25.5 cm |
Table 1. The average hemi-circumference across all manufacturers showing our new standardized bra cup measurements are shown.
Victoria Secret (VS) comprised 85% of manufacturers reported, followed by Maidenform, Bali, and Calvin Klein. Our data is therefore skewed toward VS being the most frequent bra worn. The other manufacturers varied 0.9 cm or less from the mean hemi-circumference measurement for each cup size. To further corroborate our findings, we also enlisted the services of an expert sizer from Victoria Secrets to confirm our measurements of a primary augmentation patient at a “C Cup” which we measured with a 21cm hemi-circumference in the middle of our C-Range. Reported cc’s in the literature corresponding to a bra cup range from 200-275cc’s. The average volume in cc’s to bring a patient from a B to a C or C to a D utilizing our measurement techniques and based on our data is 225cc.
Conclusion:
Bra cup measurements remain an elusive and significant variable in breast augmentation surgery. Patients and many plastic surgeons continue to use cup size as standard terminology to communicate anticipated and desired outcome bra cup ranges. However without standardization, no one is speaking the same language. Reported methods of breast measurements in the literature and by leading bra manufacturers are also variable and inconsistent further contributing to the confusion. The average C cup hemicircumference in our study is 21.3cm, the middle range of B Cup is 19 cm, 23.5 cm a D and 25.5cm a DD. Because bra cups are a continuum, a small B may be in the 18 cm range, full C 22 cm etc. In addition approximately 225cc equates to one bra cup size. The standardization of bra size language will be a significant contribution not only to our specialty, but for our patients and women in general. A simple hemicircumference measurement alone can help guide patients postoperatively to discover their specific bra cup size depending on the manufacturer they select. We are confident this new simple sizing system will be of great value and a significant contribution to our colleagues and patients on many levels.
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