Journal of Plastic, Reconstructive & Aesthetic Surgery
Understanding public perception of bra size
Introduction
In conversations between patients and their surgeons regarding breast reduction or augmentation, the cup size scale is often used to communicate about goals and expectations for postoperative results. Surgeons then often use the patient's goal cup size to guide intraoperative decision-making about reduction volume or implant size. A common practice is to sit the patient upright intraoperatively and, from the end of the table, make a judgment about whether the desired cup size has been achieved.
Cup size, however, is a poorly defined concept, with significant variation in projection and breast volume based on band size and bra manufacturer.1 Bra sizes are typically based on two parameters: cup size and band size. As part of a standard bra fitting, two measurements are obtained: the circumference of the chest just below the breasts, and the circumference of the chest at the bust, or the point of the maximum projection of the breast. The first value is the band size, and the cup size is based on the difference between the two numbers, such that a 1-inch difference is an A cup, 2 inches is a B cup, etc. A 34C bra, therefore, should indicate a chest circumference of 34 inches below the breast and 37 inches at the bust.2
These two measurements, however, leave room for significant variation. Breasts vary in shape and position as well as in size and are not perfectly symmetric, which can lead to difficulties with fit even if a size is “correct” based on measurements. This is a particular issue for women with larger and more ptotic breasts, as the natural position of the point of maximal projection of the breast is often significantly lower than where the breast will sit in a bra. Furthermore, because sizing is not based on an actual volume measurement, there is variation in the shape and volume of bra cups across bra manufacturers, even within a single size.3 The result is a system that requires significant guesswork to match an undefined shape and volume with an appropriate container.
As with most other aspects of clothing sizing, there is also a significant bias toward a small range of body shapes and sizes—typically tall, thin, and with smaller breasts—such that women outside of this narrow range face additional challenges in terms of limited selection and inconsistent attention to the different fit needs of different body types. Perception of cup size is also likely influenced by cultural factors, images in the media, and personal experience. Despite extensive literature highlighting the limitations of cup size as a metric for perioperative planning, many surgeons and patients continue to use it as if it were a broadly shared concept. To paraphrase Justice Stewart's famous line, we do not know how to define a C cup, but we know it when we see it.4
Basing preoperative discussions with patients on this unexamined assumption has the potential to lead to miscommunication between patients and their surgeons regarding postoperative expectations for some of the most common surgeries performed by plastic surgeons: breast reductions and augmentations.5 While achieving a goal size intraoperatively is an inherently approximate process, it should be guided as much as possible by the patient's goals. In this study, we sought to assess whether there is a shared, gestalt sense of what cup size means to a general population as well as to better understand how women determine their personal cup size.
Section snippets
Methods
A survey consisting of a demographic questionnaire, personal bra use questionnaire, and 27 de-identified sets of preoperative images of patient's breasts was prepared. All images were drawn from the senior author's database of preoperative patient photographs, obtained with a standardized background and standardized positions. One frontal and one oblique/three-quarter view image was included for each patient. We sought to create a sample set representative of the age and racial/ethnic
Results
A total of 421 survey respondents met the inclusion criteria for analysis. Demographics for survey respondents are listed in Table 1. Of those respondents, 191 identified that they regularly wear a bra. When those 191 respondents were asked about how they determine their personal bra size, 49.21% answered that they measure themselves to determine their bra size, 30.37% try on different bra sizes to determine their size without taking any measurements, and 20.42% obtain a professional fitting to
Discussion
The results of this study suggest that, in a general population sample, there is a shared understanding of what each cup size looks like, though this assessment matches patient-reported bra size less than half of the time. It also appears that those individuals that have more knowledge about and experience with bra sizing (women, particularly women who have had professional bra fittings or women who have had breast surgery) are the least likely to conform to the same cup size perception that is
Funding
None.
Ethical approval
Approved by the IRB of the Human Research Protections Program of the University of Pennsylvania. Confirmation #: dejddehc. Protocol Number: 850347
Declaration of Competing Interest
None declared.
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The authors have no financial disclosures to report.