OBJECTIVE: This study was undertaken to determine the optimal scoring for the Breast Evaluation Questionnaire (BEQ), and to provide evidence for its validity as a measure of comfort and satisfaction for women undergoing breast augmentation for cosmetic reasons. The BEQ is a 55-item questionnaire. A 76-item version was previously validated in in a sample of undergraduate women (non-clinical sample). The BEQ measures satisfaction with breast attributes, and comfort with general appearance and appearance of breasts while fully dressed, in a bathing-suit, and while naked, across a variety of situations. METHODS: We conducted exploratory factor analysis in 1244 women at baseline prior to the augmentation procedure. We conducted analysis of reliability of the factors, examined discriminant validity of the items of the BEQ, and examined associations between the BEQ factors and widely used measures of self-esteem and body-self relations. RESULTS: The factor analysis indicated that the BEQ is optimally scored as 3 factors: Comfort Not Fully Dressed, Comfort Fully Dressed, and Satisfaction with Breast Attributes. These factors form internally consistent subscales, which remain reliable over time (Cronbach’s ? minimum value across 4 visits was .89 for all 3 factors). We demonstrated that the items have discriminant validity. The factors are moderately correlated with the Appearance Evaluation subscale of the Multi-Dimensional Body Self Relations Questionnaire (MBSRQ) and the Physical Self subscale of the Tennessee Self-Concept Scale (TSC). CONCLUSIONS: The BEQ can now be scored with greater simplicity and greater ease of interpretation than was previously indicated.