I was flattered to have an article1 referenced by Descamps et al. in their article presenting a formula for determining resection weights for reduction mammaplasty,2 but I would like to defend the use of bra measurement for that purpose, a concept they discourage.
The authors’ statement that “bra or cup size is an unreliable indicator of breast volume” speaks to the unreliability of the traditional method of bra sizing. It is this faulty method of sizing that leads to the oft-quoted but erroneous claim that 70 (or 80) percent of women wear the wrong size bra.
For example, another article referenced by the authors determined that all of 102 women seeking breast reduction were wearing the wrong size bra,3 yet this conclusion was reached by noting that the women were all wearing bras that did not match the size predicted by the traditional method of bra sizing. It is hard to accept that not one of more than 100 women could choose the right size bra, especially because the women apparently were not examined in their own bras to check the fit, or in the bras deemed to be their correct size. I find that most of my patients have a good idea of their correct bra size and often express their desire for breast surgery in such terms.
A valid criticism of the method of bra measurement described in my original article was that no allowance was made for the variation of cup size with band size,4 but subsequent years of observation have led to a formula that does account for this variance.5 A detailed description and sizing chart is available in the more recent publication, but germane to this discussion is that for any given band size, cup size decreases by one increment with every 1-inch decrease in breast width. For example, in a size 38 band, a breast width of 10.5 inches corresponds to a D cup and 9.5 inches to a C cup. (Breast width is measured with a tape from the breast mound’s origin on the lateral chest wall, over the nipple, to its termination in the parasternal area with the patient supine. The only other measurement necessary to determine bra size is the circumference of the chest immediately below the breasts.)
To evaluate this concept, preoperative and postoperative bra size was recorded in 38 consecutive breast reduction patients and correlated to the amount of tissue resected (Fig. 1). In 13 patients categorized as being of normal weight according to a body mass index6 of 18.5 to 24.9, an average of 178 g of tissue per breast was resected for every decrease in cup size. In 16 patients categorized as overweight, with a body mass index of 25 to 29.9, an average of 221 g was resected for each cup size decrement. Nine patients categorized as being obese, with a body mass index of 30 or greater, required an average resection of 243 g per breast to reduce their bra cup by one size. Not surprisingly, these numbers are similar to the size estimates used for enlarging breasts during augmentation.
In practical terms, if a patient with an underbust circumference of 35 inches has a supine breast circumference of 13 inches, her bra size calculates to 40E5 (cup sizes are calculated in increments; e.g., C, D, DD, E, F). If her body mass index places her in the overweight range, I estimate a resection of approximately 220 g per cup size decrement. Thus, if she wishes to become a C cup, a reduction of three cup sizes, I anticipate a resection of approximately 660 cc per breast and an intraoperative reduction in her breast width to 10 inches.
The concept of using bra size to determine resection weights in reduction mammaplasty was introduced by Regnault and Daniel7 and advanced more recently by Turner and Dujon.8 I believe the time has come to embrace that method now that a more reliable method of bra sizing is available. I hope the authors will consider adding breast width and underbust circumference to their standard measurements in future breast reduction patients to see how bra size changes compare with resection weights by the formula they have devised.
Edward A. Pechter, M.D.
Division of Plastic Surgery
University of California, Los Angeles
25880 Tournament Road, Suite 217
Valencia, Calif. 91355-2844
A slide-chart for determining bra size using Dr. Pechter’s measuring system is sold commercially at www.getsizedup.com.
1. Pechter, E. A. A new method for determining bra size and predicting postaugmentation breast size. Plast. Reconstr. Surg.
102: 1259, 1998.
2. Descamps, M. J. L., Landau, A. G., Lazarus, D., and Hudson, D. A. A formula determining resection weights for reduction mammaplasty. Plast. Reconstr. Surg.
121: 397, 2008.
3. Greenbaum, A. R., Heslop, T., Morris, J., and Dunn, K. W. An investigation of the suitability of bra fit in women referred for reduction mammaplasty. Br. J. Plast. Surg.
56: 230, 2003.
4. Kanhai, R. C., and Hage, J. J. Bra cup size depends on band size (Letter). Plast. Reconstr. Surg.
104: 300, 1999.
5. Pechter, E. A. An improved technique for determining bra size with applicability to breast surgery. Plast. Reconstr. Surg.
121: 348e, 2008.
6. Department of Health and Human Services, National Institutes of Health. Calculate your body mass index. Available at: http://www.nhlbisupport.com/bmi/
. Accessed February 27, 2008.
7. Regnault, P., and Daniel, R. K. Breast reduction. In P. Regnault and R. Daniel (Eds.), Aesthetic Plastic Surgery: Principles and Techniques.
Boston: Little, Brown, 1984. Pp. 459–538.
8. Turner, A. J., and Dujon, D. G. Predicting cup size after reduction mammaplasty. Br. J. Plast. Surg.
58: 290, 2005.
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