How do respiratory state and measurement method affect bra size calculations?

Does an alternative breast support garment provide symptomatic relief for larger breasted women with chronic non-specific back pain?

BACKGROUND

Nonsurgical guidelines recommend implementing a correctly fitted bra when managing back pain among larger breasted women. Achieving this is challenging with current bra solutions, sizing principles, and fitting approaches. Persistent wearing of an ill-fitting bra can cause negative health implications, including non-specific back pain.

OBJECTIVES

This study investigated immediate and short-term biomechanical and pain responses to changing breast support garment among larger breasted women with non-specific back pain.

METHODS

Participants (n = 24) performed a standing task, drop jumps, and seated typing tasks while bra and spinal kinematic data were recorded. Five breast support conditions were assessed: participants' usual bra (control), a professionally fitted bra in the immediate term (standard) and after 4 weeks wear (standard28), and a bra with an alternative design, measurement, and fitting approach in both the immediate term (alternative) and after 4 weeks wear (alternative28). A bra fit assessment and clinical pain/disability questionnaires were included.

RESULTS

All participants failed the bra fit assessment in the control bra, compared with 87.5% (n = 21) in the standard and 4.2% (n = 1) in the alternative bras. The standard28 and alternative28 bras provided symptomatic relief, with the alternative28 bra improving a greater number of outcome measures. Reduced nipple-sternal-notch distance was observed only in the alternative28 bra condition.

CONCLUSIONS

Symptomatic relief may be associated with the resting position of the breast tissue on the anterior chest wall. The alternative bra may provide potential clinical benefit if implemented as part of a nonsurgical or conservative pain management strategy. Alternative breast support garments should be considered to provide solutions to the problems associated with traditional bras.

Increasing Breast Support is Associated With a Distal-to-Proximal Redistribution of Joint Negative Work During a Double-Limb Landing Task

Female athletes exhibit greater rates of anterior cruciate ligament injury compared with male athletes. Biomechanical factors are suggested to contribute to sex differences in injury rates. No previous investigation has evaluated the role of breast support on landing biomechanics. This study investigates the effect of breast support on joint negative work and joint contributions to total negative work during landing. Thirty-five female athletes performed 5 landing trials in 3 breast support conditions. Lower-extremity joint negative work and relative joint contributions to total negative work were calculated. Univariate analyses of variance were used to determine the effect of breast support on negative joint work values. Increasing levels of breast support were associated with lower ankle negative work (P < .001) and ankle relative contributions (P < .001) and increases in hip negative work (P = .008) and hip relative contributions (P < .001). No changes were observed in total negative work (P = .759), knee negative work (P = .059), or knee contributions to negative work (P = .094). These data demonstrate that the level of breast support affects lower-extremity biomechanics. The distal-to-proximal shift in negative joint work and relative joint contributions may be indicative of a more protective landing strategy for anterior cruciate ligament injuries.

Development of low-cost and personalized external silicone breast prosthesis produced by additive manufacturing for women who have undergone mastectomy: A pilot study

BACKGROUND

The aim of this study was to develop a low-cost and personalized method for external breast prosthesis production.

METHODS

The projected light method was used for the acquisition of the 3D geometry of the left breast of a healthy 29-year-old woman, 69 kg and 1.69 m. The 3D modeling software Blender was used to make the prosthesis model and mold with adjustments to the model's mesh, such as smoothing, assigning thickness, and creating the walls of the prosthesis mold. Two counter-molds were created. The pieces were manufactured on the 3D printer Stella Lite 3 using polylactic acid filament. Finally, the silicone was pigmented, and the mold was filled.

FINDINGS

Prototype 1 of the prosthesis was produced using a mold without a counter-mold, which resulted in a prosthesis of 495 g, considered heavy compared to traditional prostheses for the same breast size. To solve this issue, a counter-mold with pins was used to produce prototype 2 with a mass of 393 g, 20.6% lighter than prototype 1. Prototype 3 was made with a central-volume counter-mold and presented a mass of 355 g, a reduction of 28.3% compared to prototype 1. The definitive breast prosthesis was made with the pin counter-mold with a different silicone. It has nipple and areola pigmentation and a mass of 294 g, 25.2% lighter than prototype 2.

INTERPRETATION

The results suggest that the projected light method and additive manufacturing are potential tools for developing external breast prostheses, which may improve the health conditions and quality of life of mastectomized women.

Analysis on the Difference between the Practical Brassiere Size and Real Breast Volume

Background

Brassiere cup size is defined as the difference in chest circumference between the inframammary fold and the fullest part of the breast. However, a large number of women are not aware of the correct definition and are prone to wearing incorrectly-sized brassieres. In this report, the authors compared the cup size of worn brassieres and the actual measurement.

Methods

This study was a retrospective review of patients who had undergone breast reconstruction operation between May 2020 and June 2021. All patients who visited the plastic surgery clinic for breast reconstruction were inquired about their cup size, and their breast circumferences were measured. The patient demographic information, ptosis grade, mastectomy specimen weight, measured breast circumference, and known cup size were analyzed.

Results

Overall, 163 women were included. Notably, 92 of 163 patients (56.4%) were wearing a correctly-sized brassiere. Patients were more likely to wear a correctly-sized brassiere as the cup size became smaller. Moreover, patients with A-cup breasts tended to wear larger brassieres, whereas patients with B and C-cup breasts tended to wear smaller brassieres than their actual breast cup size.

Conclusions

Approximately one in two women do not know their correct brassiere cup size. Women tend to wear a brassiere of the wrong size as their cup size becomes larger. Therefore, it is important for surgeons to be aware of their patient's brassiere wearing habit and their perception when a surgery, such as augmentation or reconstruction, is planned.

Challenges in developing a quantitative method of measuring breast development using 3D imaging: An example of a novel method for use in induced breast development with exogenous oestrogen

OBJECTIVE

Optimal breast development is an essential part of exogenous oestrogen treatment in females undergoing pubertal induction. We set out to develop a novel technique using three-dimensional (3D) imaging to determine change in breast volume that is applicable when no pre-existing breast contours are present.

DESIGN

A prospective observational study.

PATIENTS

The imaging methodology was developed using a single male subject to assess reproducibility and validity. The technique was then applied to 29 participants undergoing pubertal induction with exogenous oestradiol who were recruited from Paediatric Gynaecology and Reproductive Endocrinology clinics at University College London Hospital.

MEASUREMENTS

Breast images were taken using a 3D photographic system. Two images, taken at different times, were manually superimposed to produce a differential breast volume. The initial step of method development set out to show that volume change was not secondary to positioning artefact or image manipulation. This was established by using images of a male participant taken on different occasions. The technique was then used to assess reproducibility in participants undergoing pubertal induction treatment.

RESULTS

Good intraobserver reproducibility (intraclass correlation (ICC) 0.77) was demonstrated with static image manipulation. Validity of the imaging technique was established as there was no significant difference between the known reference volume produced by computer generated warping and that calculated by manual image manipulation. There was excellent intraobserver reproducibility for breast volume calculation in participants undergoing induced breast development (ICC 0.99).

CONCLUSIONS

3D imaging is a promising novel tool to provide quantitative breast volume assessment in individuals undergoing breast induction with exogenous oestradiol treatment.

The impact of breast support garments on fit, support and posture of larger breasted women

Due to current measurement, sizing and fitting approaches, poor bra fit is prevalent amongst larger breasted women. The impact of improving bra fit hasn't yet been explored. This pre-clinical study aimed to explore immediate and short-term biomechanical responses to changing breast support garment. Asymptomatic participants (n=24) performed a static standing task, drop jumps and seated typing whilst kinematic data from the breasts and spine were recorded. Three breast support conditions were assessed: Usual, professionally fitted bra in the immediate term (PFB), and the same professionally fitted bra after four weeks wear (PFB₂₈). Bra fit assessments were included for both bras. All participants failed the bra fit assessment when wearing the Usual bra and 67% (n=16) failed when wearing the PFB. Less bra fit issues were present in the PFB, resulting in immediate biomechanical changes relating to breast support and spinal posture, yet nothing in the short term (PFB₂₈). This research sets the foundations for future work to investigate whether the implementation of better fitting breast support garments can influence musculoskeletal pain amongst larger breasted women, whilst attributing potential improvement of symptoms, objective measures of breast support and spinal posture.

ESSM Position Statement "Sexual Wellbeing After Gender Affirming Surgery"

Introduction

Much has been published on the surgical and functional results following Gender Affirming Surgery (‘GAS’) in trans individuals. Comprehensive results regarding sexual wellbeing following GAS, however, are generally lacking.

Aim

To review the impact of various GAS on sexual wellbeing in treatment seeking trans individuals, and provide a comprehensive list of clinical recommendations regarding the various surgical options of GAS on behalf of the European Society for Sexual Medicine.

Methods

The Medline, Cochrane Library and Embase databases were reviewed on the results of sexual wellbeing after GAS.

Main Outcomes Measure

The task force established consensus statements regarding the somatic and general requirements before GAS and of GAS: orchiectomy-only, vaginoplasty, breast augmentation, vocal feminization surgery, facial feminization surgery, mastectomy, removal of the female sexual organs, metaidoioplasty, and phalloplasty. Outcomes pertaining to sexual wellbeing- sexual satisfaction, sexual relationship, sexual response, sexual activity, enacted sexual script, sexuality, sexual function, genital function, quality of sex life and sexual pleasure- are provided for each statement separately.

Results

The present position paper provides clinicians with statements and recommendations for clinical practice, regarding GAS and their effects on sexual wellbeing in trans individuals. These data, are limited and may not be sufficient to make evidence-based recommendations for every surgical option. Findings regarding sexual wellbeing following GAS were mainly positive. There was no data on sexual wellbeing following orchiectomy-only, vocal feminization surgery, facial feminization surgery or the removal of the female sexual organs. The choice for GAS is dependent on patient preference, anatomy and health status, and the surgeon's skills. Trans individuals may benefit from studies focusing exclusively on the effects of GAS on sexual wellbeing.

Conclusion

The available evidence suggests positive results regarding sexual wellbeing following GAS. We advise more studies that underline the evidence regarding sexual wellbeing following GAS. This position statement may aid both clinicians and patients in decision-making process regarding the choice for GAS. Özer M, Toulabi SP, Fisher AD, et al. ESSM Position Statement “Sexual Wellbeing After Gender Affirming Surgery”. Sex Med 2022;10:100471.

Can Physical Characteristics and Sports Bra Use Predict Exercise-Induced Breast Pain in Elite Female Athletes?

OBJECTIVE

To evaluate whether a simple 4-factor model using self-reported data could be used to predict exercise-induced breast pain in elite female athletes.

DESIGN

Survey study.

SETTING

Online or hard-copy surveys completed at sporting competitions and training facilities around Australia.

PARTICIPANTS

Four hundred ninety female athletes competing nationally or internationally across 49 sports.

INDEPENDENT VARIABLES

A binomial logistic regression analysis was used to evaluate the strength of a predictive model that included 2 continuous independent variables (age and body mass index) and 2 binary independent variables (breast size and sports bra use). Odds ratios were also calculated to determine the likelihood of an athlete reporting exercise-induced breast pain in association with each of the 4 variables.

MAIN OUTCOME MEASURES

Exercise-induced breast pain was the binary dependent variable.

RESULTS

The model incorporating athlete age, breast size, body mass index, and sports bra use was found to be statistically significant, but weak, in its ability to predict exercise-induced breast pain in elite female athletes (correctly identified 66% of athletes). For every 1-year increase in age, a significant 2.6% increase in the likelihood of experiencing exercise-induced breast pain was observed. Athletes with medium-to-hypertrophic sized breasts were 5.5 times more likely to experience exercise-induced breast pain than athletes with small breasts.

CONCLUSIONS

Although the current model was not sensitive enough for use by clinicians and coaches, age and breast size were both identified as critical variables in the prediction of exercise-induced breast pain. Future research is encouraged to investigate whether incorporating additional variables such body fat percentage, bra fit, and other relevant factors can add strength to the model.

Bigger Bust No Longer on Trend: Malaysians Prefer Moderation in Ideal Female Breast Augmentation

Background It is important to correctly determine the ideal female breast anatomy and aesthetic proportions in order to prepare for surgery and establish its goals. Leaving the preference to the operating surgeons alone might leave unsatisfactory results, which especially leads to reoperation, quite often in the aspect of breast dimension.

Methods This study was conducted using an online graphic questionnaire. We attempted to seek male and female perspectives toward their preferred ideal female breast size for breast augmentation, in order to provide up-to-date data to assist breast surgeons in attaining satisfactory surgical results.

Results Sixty males and 67 females participated in the study comprising Asian major ethnicities of Malay, Chinese, and Indian. Universally, 46.6% of men and 53.5% of women preferred 30 mm diameter for the most ideal nipple-areola complex (NAC) size. For the perfect bust, they generally favored size C and D cup (37.8% and 38.5%, respectively).

Conclusion The majority of women seek natural breast beauty and the longing for an oversized look appears to have infiltrated practice but these assumptions have finally been challenged by these findings.

The incidence of breast health issues and the efficacy of a sports bra fit and issue service in British Army recruits

Increasing retention of female recruits throughout Basic Training (BT) is a key priority for the British Army. The aims of this study were two-fold; (i) quantify breast health issues and sports bra usage within female British Army recruits, and (ii) assess the influence of professionally fitted sports bras on breast health and bra fit issues across 13 weeks of BT. A survey was completed by 246 female recruits that identified the incidence of breast health issues during BT. Subsequently, 33 female recruits were provided with professionally fitted sports bras during Week-1 of BT. Recruits completed a survey in Week-1 (Pre) and Week-13 (Post). There was a high incidence of bra issues during BT, which did not reduce following the implementation of professionally fitted sports bras. The authors recommend further research into the specific functional requirements of breast support relative to the demands of BT and the needs of the female recruit. Practitioner Summary: The British Army have a duty of care to ensure female recruits are equipped sufficiently for the demands of training. Despite the implementation of a sports bra fitting and issue service bra fit issues remained high. Further research into the specific functional requirements of breast support during training is recommended. Abbreviations: BT: Basic Training; ATR(W): Army Training Regiment Winchester; ATC(P): Army Training Centre Pirbright; BMI: Body Mass Index; NRS: Numeric Rating Scale; FET: Fisher's Exact Test.

Breast Biomechanics: What Do We Really Know?

Although half the world's population will develop breasts, there is limited research documenting breast structure or motion. Understanding breast structure and motion, however, is imperative for numerous applications, such as breast reconstruction, breast modeling to better diagnose and treat breast pathologies, and designing effective sports bras. To be impactful, future breast biomechanics research needs to fill gaps in our knowledge, particularly related to breast composition and density, and to improve methods to accurately measure the complexities of three-dimensional breast motion. These methods should then be used to investigate breast biomechanics while individuals, who represent the full spectrum of women in the population, participate in a broad range of activities of daily living and recreation.

Breast Education Improves Adolescent Girls' Breast Knowledge, Attitudes to Breasts and Engagement With Positive Breast Habits

Many females experience breast-related issues that are considered to negatively impact health and well-being. These include breast cancer, issues related to incorrect bra fit, and issues related to breast movement including an increased incidence of breast pain, breast sag, and embarrassment, which can be a barrier to physical activity participation. Knowledge and awareness of these breast issues among females is low. Furthermore, these breast concerns are more prevalent in adolescent girls compared to adult females, with 87% of girls reporting ≥ one breast concern. This study evaluated the short- and longer-term impact of a 50 min breast education intervention on adolescent girls' (11 to 14 years) breast knowledge, attitudes to breasts and engagement with positive breast habits. A mixed methods, controlled, longitudinal, cohort design was employed, using two control schools (n: 412; receiving no intervention) and two intervention schools (n: 375; receiving the intervention) from privileged and less privileged areas. Adolescent girls in four schools completed a validated breast survey pre- and immediately post-intervention as well as 3 and 6 months post-intervention. Additionally, in one intervention school, six focus groups were conducted immediately and 4 months after the intervention. The intervention was equally effective in the two intervention schools. Following the intervention, participants in the intervention schools significantly improved their breast knowledge, their attitudes to breasts and their engagement with positive breast habits, compared to participants in the control schools, p < 0.01 (with large effect sizes). These improvements were sustained 6 months post-intervention. Participants described the session as "informative," it made them "feel less embarrassed" about their breasts; they also reported wanting to do more exercise and to change their bra purchasing and bra wearing habits. These novel, positive findings provide insight into the benefits of teaching adolescent girls about breasts from a young age and can be used to inform effective breast education in schools. It is recommended that education on multiple breast topics should be introduced in schools, preferably being first introduced in primary schools, with a modular structure and progressive information.

Biomechanics of Breast Support for Active Women

More systematic breast biomechanics research and better translation of the research outcomes are necessary to provide information upon which to design better sports bras and to develop effective evidence-based strategies to alleviate exercise-induced breast pain for women who want to participate in physical activity in comfort.

Sports bra but not sports footwear decreases breast movement during walking and running

Running is a modality that has a large number of adepts, including women. Therefore, it is important to understand how sportswear can help women, with special attention to the breast movement. The aim of this study was to analyse the effect of different combinations of breast support and footwear on the breast movement during walking and running. Twenty women performed treadmill walking (5 km/h) and running (7 and 10 km/h) combining different footwear (barefoot, minimalist, and traditional) and breast support conditions (bare breast, everyday bra, and sports bra). Three-dimensional data from breast and trunk markers were tracked for 10 stride cycles. Relative breast displacement was calculated and derived for velocity. An interaction effect was observed between support, footwear, and speed conditions. The bare breast conditions presented differences from the other conditions in the majority of the kinematic variables, presenting higher breast displacement and velocity values. On the other hand, the sports bra conditions presented the lowest values for the kinematics variables. In the vertical component of breast displacement during running (10 km/h) we verified that the sports bra presented reductions of 56% and 43% in relation to the bare breast and everyday bra conditions, respectively. Despite this, no differences were found between footwear within each breast support condition. A sports bra is efficient to decrease breast movement. In addition, neither of the tested footwear was able to decrease these movements.

Effects of sports bra and footwear on vertebral posture during walking and running

Little attention has been given to factors which affects women running, such as proper footwear and breast support and their effects on spine. The objective of study was to analyse the influence of different breast support and footwear on vertebral posture during walking and running. Seventeen women (x¯ = 23.51; SD = 3.70 years) performed a treadmill walking (5 km/h) and running (7 and 10 km/h) with different footwear (barefoot, minimalist and traditional) and breast support (bare breast, everyday bra and sports bra) conditions. Spine movements were analyzed using three cameras in grayscale video mode, positioned behind the participant to register reflective markers fixed in the vertebrae. From the 3D coordinates of the trunk markers we computed, for the whole gait cycle (C) and for the average gait posture (neutral curve-NC) the maximal (M) thoracic (T) kyphosis and lateral flexion, and the maximal lumbar (L) lordosis and lateral flexion. Frontal plane: bare breast presented higher lumbar NC than the everyday bra and sports bra, higher MLC than the sports bra and lower MTC than the everyday bra and sports bra. Barefoot presented higher MTC than minimalist. Sagittal plane: bare breast presented lower MTC than the sports bra. Barefoot presented higher lumbar NC than the minimalist and traditional footwear and higher MLC than the minimalist and traditional ones. The sports bra increased curvatures in the thoracic spine that were rectified during bare breast conditions. In addition, both footwears were able to maintain the natural curvatures of the spine in the lumbar.

The relationship between breast size and aspects of health and psychological wellbeing in mature-aged women

OBJECTIVES

Increases in breast size with age are common but have not been widely examined as a factor that could affect the health and psychological wellbeing of mature-aged women. The purpose of this study was to examine the relationships between breast size and aspects of health and psychological wellbeing in mature-aged women.

METHODS

This was a cross-sectional study of mature-aged women (⩾40 years). Breast size (breast size score) was determined from self-reported bra size and was examined against health-related quality of life (Medical Outcomes Study Short-Form 36 and BREAST-Q), body satisfaction (numerical rating scale), breast satisfaction (BREAST-Q), physical activity levels (Human Activity Profile), the presence of upper back pain and breast and bra fit perceptions.

RESULTS

Two hundred sixty-nine women (40-85 years) with bra band sizes ranging from 8 to 26 and bra cup sizes from A to HH participated. The mean (standard deviation) breast size score of 7.7 (2.7) was equivalent to a bra size of 14DD. Increasing breast size was associated with significantly lower breast-related physical wellbeing (p < 0.001, R2 = 0.043) and lower ratings of body (p = 0.002, R2 = 0.024) and breast satisfaction (p < 0.001, R2 = 0.065). Women with larger breasts were more likely to be embarrassed by their breasts (odds ratio: 1.49, 95% confidence interval: 1.31 to 1.70); more likely to desire a change in their breasts (odds ratio: 1.55, 95% confidence interval: 1.37 to 1.75) and less likely to be satisfied with their bra fit (odds ratio: 0.84, 95% confidence interval: 0.76 to 0.92). Breast size in addition to age contributed to explaining upper back pain. For each one-size increase in breast size score, women were 13% more likely to report the presence of upper back pain.

CONCLUSION

Larger breast sizes have a small but significant negative relationship with breast-related physical wellbeing, body and breast satisfaction. Larger breasts are associated with a greater likelihood of upper back pain. Clinicians considering ways to improve the health and psychological wellbeing of mature-aged women should be aware of these relationships.

The Occurrence, Causes and Perceived Performance Effects of Breast Injuries in Elite Female Athletes

Female breasts are vulnerable to direct blows or frictional injuries during sport; however, little research has investigated breast injuries experienced by female athletes. This study aimed to investigate the occurrence, causes and perceived performance effects of breast injuries in elite female athletes across a wide range of sports. A custom-designed survey was distributed to female athletes aged over 18 years who were competing nationally or internationally in their chosen sport. The survey included questions about breast injuries sustained during training and competition and any perceived performance effects of these injuries. 504 elite female athletes from 46 different sports completed the survey. 36% of participants (n = 182) reported experiencing breast injuries and 21% (n = 37) perceived that their breast injury negatively affected their performance. Contact breast injuries were reported by significantly more athletes involved in contact or combat sports and by athletes with larger breasts or a higher body mass index. Frictional breast injuries were reported by significantly more older athletes or those with larger breasts. Less than 10% of participants who experienced breast injuries reported their injury to a coach or medical professional and only half used any prevention strategies. Athletes, coaches and medical professionals associated with women's sport need to be made aware of the occurrence and potential negative effects of breast injuries. It is critical to normalise conversations around breast health so that athletes can be encouraged to report and, when necessary, receive treatment for breast injuries. Further research is also required to better understand factors that affect breast injuries in sport in order to develop evidence-based breast injury prevention strategies.

Effects of age and body mass index on breast characteristics: a cluster analysis

Limited research has quantified variation in the characteristics of the breasts among women and determined how these breast characteristics are influenced by age and body mass. The aim of this study was to classify the breasts of women in the community into different categories based on comprehensive and objective measurements of the characteristics of their breasts and torsos, and to determine the effect of age and body mass index on the prevalence of these breast categories. Four breast characteristic clusters were identified (X-Large, Very-ptotic & Splayed; Large, Ptotic & Splayed; Medium & Mildly-ptotic; and Small & Non-ptotic), with age and BMI shown to significantly affect the breast characteristic clusters. These results highlight the difference in breast characteristics exhibited among women and how these clusters are affected by age and BMI. The breast characteristic clusters identified in this study could be used as a basis for future bra designs and sizing systems in order to improve bra fit for women. Practitioner summary: This original research provides evidence for bra designers and manufacturers on the diverse breast characteristics exhibited by women within the population and the significant effect that both body mass index and age have on the breast characteristic clusters. Future bra designs should consider the variation in breast characteristics among women.

ABBREVIATIONS

BMI: Body Mass Index; UBCC: Under-bust chest circumference.

Bra band size measurements derived from three-dimensional scans are not accurate in women with large, ptotic breasts

This study investigated differences in standard measurements used to determine bra size, under-bust chest circumference (UBCC) and over-bust chest circumference (OBCC), measured from a three-dimensional scan (hand-held scanner) compared to the direct measurement in 111 women (age 21-56 years; right breast volume 57-1672 mL; bra size 10A-18G). Bland-Altman plots of UBCC measurements showed a large positive bias and wide limits of agreement (12 cm; -4.6 to 28 cm), which increased as band size increased but decreased when the breasts were digitally removed from the scan prior to the UBCC measurement. The difference in UBCC measurements determined from scans compared to direct measurement had a strong positive correlation with breast volume and breast ptotis. The OBCC measurements showed a small positive bias (2.4 cm; -3.4 to 8.4), consistent across the range of bra sizes. Bra band size measurements determined from three-dimensional scans can be inaccurate in women with large, ptotic breasts. Practitioner Summary: We investigated potential errors in anthropometric data derived from three-dimensional scans used for bra design and fit. Bra band size measurements taken from three-dimensional scans were over-estimated in women with large breasts, whereas bra cup size measurements were accurate to within one-cup size across the entire range of bra sizes.

Breast Development in Transwomen After 1 Year of Cross-Sex Hormone Therapy: Results of a Prospective Multicenter Study

CONTEXT

Breast development is a key feature of feminization and therefore important to transwomen (male-to-female transgender persons). It is not exactly known when breast development starts after initiating cross-sex hormone therapy (CHT) and how much growth may be expected.

OBJECTIVE

To investigate breast development in transwomen during their first year of CHT and whether clinical or laboratory parameters predict breast development.

DESIGN

This study was performed as part of the European Network for the Investigation of Gender Incongruence, which is a prospective multicenter cohort study.

SETTING

Gender clinics in Amsterdam, Ghent, and Florence.

PARTICIPANTS

Transwomen who completed the first year of CHT (n = 229).

INTERVENTION

CHT.

MAIN OUTCOME MEASURES

Breast development in centimeter and cup size.

RESULTS

The median age of the included transwomen was 28 years (range, 18 to 69). Mean breast-chest difference increased to 7.9 ± 3.1 cm after 1 year of CHT, mainly resulting in less than an AAA cup size (48.7%). Main breast development occurred in the first 6 months of therapy. Serum estradiol levels did not predict breast development after 1 year of CHT (first quartile, 3.6 cm [95% confidence interval (CI), 2.7 to 4.5], second quartile, 3.2 cm [95% CI, 2.3 to 4.2], third quartile, 4.4 cm [95% CI, 3.5 to 5.3], and fourth quartile, 3.6 cm [95% CI, 2.7 to 4.5]).

CONCLUSION

This study shows that, after 1 year of CHT, breast development is modest and occurs primarily in the first 6 months. No clinical or laboratory parameters were found that predict breast development.

Three-dimensional scanning in women with large, ptotic breasts: implications for bra cup sizing and design

BACKGROUND

This study aimed to compare breast volume calculated from scanning large, ptotic breasts of women while they were standing upright relative to when lying prone in order to identify the error associated with breast volume calculations.

METHODS

Breast volume and visualisation were compared in 50 women with large breasts (D⁺ bra cup size) while they were scanned in three different positions.

RESULTS

Full visualisation of both breasts occurred in 100% of participants in the prone position and only 5% of participants in either standing position. Breast volume was significantly greater (p < 0.01) in the prone position, with the percentage of underestimation in the standing position increasing as breast volume increased.

CONCLUSION

Breast volume measured by three-dimensional scanning in the standing position will be underestimated by 7-10% in large, ptotic breasts. Consideration of these inaccuracies in breast volume relative to breast size can assist bra manufacturers when designing bras. Practitioner Summary: Errors have been reported when measuring the breast volume of women with large, ptotic breasts using three-dimensional scanning. This original research provides evidence for bra designers and manufacturers on the degree of error associated with this measurement. These errors should be accounted for in future bra designs.

Breast size impacts spine motion and postural muscle activation

BACKGROUND

While it is generally accepted that large breast sizes in females contribute to back pain and poor posture, the effects of breast size on spinal motion and muscle activation characteristics are poorly understood.

OBJECTIVE

This study examined the relationship between breast size, spine motion, and trunk muscle activation.

METHODS

Fifteen university-aged females, free of back pain symptoms, were tested. Breast sizes were calculated, and three-dimensional spine motion and activation from five trunk muscles bilaterally were measured during standing and trunk flexion movements. Correlations between breast size and motion and muscle activation measures were assessed.

RESULTS

Head and trunk angles were strongly, negatively correlated to breast size during upright standing; thoracic angles were moderately, positively correlated to breast size during thoracic flexion movements. Trunk muscles showed positive, moderate-strength relationships with breast size during upright standing and some trunk movements.

CONCLUSIONS

These findings provide a preliminary indication that increasing breast sizes are associated with altered postures and increased muscle activation in a non-clinical population, and constitute a baseline for the study of females with a full range of breast sizes. Further research is required to confirm the generalizability of these findings to other sizes, in order to inform strategies for the prevention or reduction of back pain, as well as diagnosis, treatment, and rehabilitation techniques associated with breast size and back pain.

The influence of ageing on bra preferences and self-perception of breasts among mature women

The ageing process has both psychological and physiological effects on women, and tactical choices are often made regarding beauty interventions to mask the outward signs of increasing age. The bra is believed to counteract the negative effects of ageing on the breast and alter the perceptions of one's body. Due to the profound anatomical changes to the breast with increasing age, this paper aimed to examine the influence of ageing on women's perceptions of their breasts and their bra preferences. 208 women aged 45-65 years were surveyed about their breasts, their bras and how they felt ageing may have influenced these. The findings showed 80 % of women surveyed had noticed a significant change in their breasts with ageing, just 7 % of the women surveyed were still proud of their breasts and 84 % of women dressed to look younger. Further, over 50 % of respondents would now not wear the bra they had worn in their twenties, indicating a change in bra preferences with age. The bra variables of primary importance to participants were: comfort, the bra's ability to stay in place, optimal fit, appearance under clothing, support, discreetness, shoulder strap design, silhouette, breast shape, fabric and breast lift. These variables are perceived as being influential in the appropriateness of the bra and its social role for mature women; therefore, it is these bra variables that should be the focus of subsequent research regarding the optimisation of bras for women aged 45-65 years.

Breast size, thoracic kyphosis & thoracic spine pain - association & relevance of bra fitting in post-menopausal women: a correlational study

BACKGROUND

Menopause would seem to exist as a period of accelerated changes for women and their upper torso mechanics. Whether these anthropometric changes reflect changes in pain states remains unclear. Plausible mechanisms of pain exist for the independent and combined effect of increasing breast size and thoracic kyphosis. Bra fit has the potential to change when the anthropometric measures (chest circumference and bust circumference) used to determine bra size change, such as postmenopausally.Identifying an association between breast size, thoracic kyphosis and thoracic spine pain in postmenopausal women and identifying the relevance of bra fit to this association may be of importance to the future management and education of post-menopausal women presenting clinically with thoracic spine pain.

METHODS

A cross-sectional study design. Fifty-one postmenopausal bra-wearing women were recruited. Measures included breast size (Triumph International), thoracic kyphosis (flexible curve), bra fitted (Y/N) and pain (Short Form McGill Pain Questionnaire) and tenderness on palpation (posteroanterior pressure testing). These measures were collected in one session at a physiotherapy clinic.

RESULTS

The majority of the women in this study were overweight or obese and wearing an incorrect sized bra. Pain was significantly related to breast size, body weight and BMI at mid thoracic levels (T7-8). In contrast self-reported thoracic pain was not correlated with age or index of kyphosis (thoracic kyphosis). Women with thoracic pain were no more likely to have their bra professionally fitted whereas women with a higher BMI and larger breasts were more likely to have their bra professionally fitted.

CONCLUSION

The findings of this study show that larger breasts and increased BMI are associated with thoracic pain in postmenopausal women. This is unrelated to thoracic kyphosis. Increasing breast size and how a bra is worn may have biomechanical implications for the loaded thoracic spine and surrounding musculature. Post-menopause women present with a spectrum of anthropometrical changes that have the potential to contribute to altered biomechanics and affect pain states in the thoracic spine.

Female upper body and breast skin temperature and thermal comfort following exercise

Breast support reduces breast pain and movement during exercise, however, an extra layer of clothing may affect thermoregulation. This preliminary study investigated female upper body and breast skin temperature and thermal comfort following short-duration exercise. Eight female participants with C-cup breasts had thermal images (infra-red camera, FLIR systems) of the bare breasts, the breasts in two sports bras (composite and polyester) and the abdomen, taken before and after 20 min of exercise at 28(o)C. Following exercise, bare-breast, bra and abdomen temperatures reduced by 0.61(o)C, 0.92(o)C and 2.06(o)C, respectively. The polyester sports bra demonstrated greater thermal comfort and enabled a greater change in skin temperature than the composite sports bra. It is concluded that following short-duration exercise, sports bras reduced the cooling ability of the breast. Material properties of the bras affect thermal comfort and post-exercise skin temperature; this should be an important consideration for sports bra manufacturers.

PRACTITIONER SUMMARY

This study investigates the effect of sports bras on thermal regulation of the breast following exercise. Sports bras negatively affected the cooling ability of the skin on the breast, with the material properties of the bra affecting thermal comfort following exercise. These results present important considerations for sports bra manufacturers.

Bra-breast forces generated in women with large breasts while standing and during treadmill running: Implications for sports bra design

This study aimed to determine the bra-breast forces generated in women with large breasts while these women wore different levels of breast support during both upright standing and treadmill running. The mean bilateral vertical component of the bra-breast force in standing was 11.7 ± 4.6 N, whereas during treadmill running the mean unilateral bra-breast force was 8.7 ± 6.4 N and 14.7 ± 10.3 N in the high and low support conditions, respectively. Furthermore, breast mass was significantly correlated with vertical breast displacement (R(2) = 0.62) in the high support condition. The wide range of breast masses of women with large breasts is an important consideration for designers of sports bras to ensure these bras can reduce force generation and breast discomfort by providing a high level of breast support while these women participate in physical activity.

Evaluation of professional bra fitting criteria for bra selection and fitting in the UK

A correctly fitting bra is essential for good health; this study investigates the use of professional bra fitting criteria to establish best-fit in an underwire bra commonly sold in the UK. A comparison was made between women's bra size as measured by the traditional bra fitting method with their recommended bra size based on professional bra fitting criteria. Forty-five female participants were recruited; their mode self-reported bra size was 34DD. Participants were measured in their own bra using the traditional bra-fitting method to establish their 'traditional size'. A 'best-fit' bra size was recorded for participants based on professional bra fitting criteria. Significant differences were found between traditional and best-fit cup and band sizes (p < 0.001); the traditional method of bra fitting overestimated band size and underestimated cup size. As band size increased the traditional method also became more inaccurate (p < 0.001). It is recommended that women are educated in assessing their own bra fit using professional bra fitting criteria and less emphasis placed on determining absolute bra size. Practitioner Summary: This is the first study to investigate using professional bra fitting criteria to establish best-fit in an underwired bra commonly sold in the UK. The traditional method of bra fitting was found to be inadequate, especially for larger-breasted women; the use of professional bra fitting criteria should be encouraged.

The relationship between breast size and anthropometric characteristics

OBJECTIVES

Current clinical selection criteria for mammaplasty use weight-related parameters, and weight loss is recommended as a nonsurgical intervention to reduce breast size. However, research has not firmly established if breast size is related to body size and composition. This study aims to investigate anthropometric characteristics in smaller and larger breasted women and identify predictors of breast mass.

METHODS

A bra fitter determined underband and cup size of 93 A to H cup size women (mean ± standard deviation, age 25.7 ± 5.6 years, height 1.67 ± 0.6 cm, and mass 65.6 ± 11.0 kg). Estimations of breast mass (g) were made, and participants were categorized as smaller (<500 g) or larger (>500 g) breasted. Restricted anthropometric profiles determined body mass, height, body mass index (BMI), waist-to-hip ratio, sum of eight skinfolds, subscapular to triceps skinfold ratio, somatotype, percent body fat, fat and fat-free mass, and suprasternal notch to nipple distance.

RESULTS

All variables (excluding height, subscapular to triceps skinfold ratio, and age) were significantly greater in larger breasted women. Body mass-related parameters and suprasternal notch to nipple distance were positively related to breast mass, with BMI and suprasternal notch to nipple distance accounting for half of the variance in breast mass.

CONCLUSION

Smaller and larger breasted women demonstrate differences in anthropometry, with body mass and BMI demonstrating strong relationships to breast mass. Measures of BMI and suprasternal notch to nipple distance enable predictions of breast mass and suggest that weight-related parameters are not appropriate exclusion criteria for mammaplasty.

A Comparison of Three-Dimensional Breast Displacement and Breast Comfort During Overground and Treadmill Running

Comparisons of breast support requirements during overground and treadmill running have yet to be explored. The purpose of this study was to investigate 3D breast displacement and breast comfort during overground and treadmill running. Six female D cup participants had retro-reflective markers placed on the nipples, anterior superior iliac spines and clavicles. Five ProReflex infrared cameras (100 Hz) measured 3D marker displacement in four breast support conditions. For overground running, participants completed 5 running trials (3.1 m/s ± 0.1 m/s) over a 10 m indoor runway; for treadmill running, speed was steadily increased to 3.1 m/s and 5 gait cycles were analyzed. Subjective feedback on breast discomfort was collected using a visual analog scale. Running modality had no significant effect on breast displacement (p> .05). Moderate correlations (r= .45 to .68,p< .05) were found between breast discomfort and displacement. Stride length (m) and frequency (Hz) did not differ (p< .05) between breast support conditions or running modalities. Findings suggest that breast motion studies that examine treadmill running are applicable to overground running.

Three-Dimensional Kinematics of the Breast during a Two-Step Star Jump

Anecdotal reports suggest two-step star jumps cause excessive breast movement and discomfort, leading to recommendations for this activity as a diagnostic tool to determine effective breast support in a retail environment. The aim was to investigate multiplanar bare-breast kinematics during the two-step star jump and to establish the relationship between breast kinematics, discomfort and cup size. Thirty-nine females completed five two-step star jumps with no breast support after which breast discomfort was rated. To establish relative breast kinematics infrared cameras tracked the 3D co-ordinates of breast and body markers. Maximum resultant breast displacement, velocity and acceleration during jumping reached 18.7 cm, 93.1 cm·s−1and 3.6g, respectively. Significantly more vertical breast displacement (p< 0.01) and velocity (p< 0.01) occurred compared with mediolateral and anteroposterior kinematics. Breast discomfort increased as cup size increased (r= .61). Two-step star jumping stimulated multiplanar breast kinematics and high levels of breast discomfort. Therefore, this activity may be useful in a retail outlet to determine the function and comfort of a sports bra.

Education improves bra knowledge and fit, and level of breast support in adolescent female athletes: a cluster-randomised trial

QUESTIONS

Can an education booklet handed out by a physiotherapist improve bra knowledge and fit, and level of breast support, of bras worn by adolescent female athletes?

DESIGN

Cluster-randomised trial with intention-to-treat analysis.

PARTICIPANTS

115 adolescent females from four regional sporting academies aged 16 yr (SD 1) and with an average Australian bra size of 12B.

INTERVENTION

The experimental group received an education booklet on bra fit and breast support from a sports physiotherapist. The control group received no intervention.

OUTCOME MEASURES

The primary outcome was bra knowledge measured by a questionnaire. Secondary outcomes were a pass on the Bra Fit Assessment and the Level of Breast Support tests, and breast discomfort during exercise rated on a 10-cm visual analogue scale.

RESULTS

Four months after receiving the education booklet, the experimental group had improved their bra knowledge 19% (95% CI 14 to 25) more than the control group. In addition, 39% (95% CI 19 to 54) more of the experimental group passed the Bra Fit Assessment test and 30% (95% CI 11 to 47) more passed the Level of Breast Support test than the control group at 4 months. There was no difference in the level of breast discomfort during exercise.

CONCLUSION

Bra knowledge, bra fit, and level of breast support in adolescent female athletes were all poor but improved significantly after receiving an education booklet about breast support designed specifically for them.

TRIAL REGISTRATION

ACTRN12609000607279.

Breast Displacement in Three Dimensions during the Walking and Running Gait Cycles

This study aimed to assess the trajectory of breast displacement in 3 dimensions during walking and running gait, as this may improve bra design and has yet to be reported. Fifteen D-cup participants had reflective markers attached to their nipples and trunk to monitor absolute and relative breast displacement during treadmill walking (5 kph) and running (10 kph). During the gait cycle, the breast followed a figure-of-eight pattern with four movement phases. Despite a time lag in resultant breast displacement compared with the trunk, similar values of breast displacement were identified across each of the four phases. Fifty-six percent of overall breast movement was vertical, suggesting that 3-D assessment and the elimination of trunk movement in 6 degrees of freedom are essential to accurately report breast displacement during the gait cycle.

Does deep water running reduce exercise-induced breast discomfort?

AIM

To establish whether exercise-induced vertical breast displacement and discomfort in women with large breasts were reduced during deep water running compared to treadmill running.

METHODS

Sixteen women (mean age = 32 years, range 19-43 years; mean mass = 74.1 kg, range 61-114 kg; mean height = 1.7 m, range 1.61-1.74 m), who were professionally sized to wear a C+ bra cup, were recruited as representative of women with large breasts. After extensive familiarisation, vertical breast motion of the participants was quantified as they ran at a self-selected stride rate on a treadmill and in 2.4 m deep water. Immediately after running, the subjects rated their breast discomfort and breast pain (visual analogue scale) and their perceived exertion (Borg scale). Breast discomfort, breast pain, perceived exertion, vertical breast displacement and vertical breast velocity were compared between the two experimental conditions.

RESULTS

Exercise-induced breast discomfort was significantly less and perceived exertion was significantly greater during deep water running relative to treadmill running. Although there was no significant between-condition difference in vertical breast displacement, mean peak vertical breast velocity was significantly (p<0.05) less during deep water (upward mean (SD): 29.7 (14.0) cm x s(-1); downward: 31.1 (17.0) cm x s(-1)) compared to treadmill running (upward mean (SD): 81.4 (21.7) cm x s(-1); downward: 100.0 (25.0) cm x s(-1)).

CONCLUSION

Deep water running was perceived as a more strenuous but comfortable exercise mode for women with large breasts. Increased comfort was attributed to reduced vertical breast velocity rather than reduced vertical breast displacement.