An Aesthetic Factor Priority List of the Female Breast in Scandinavian Subjects

Abstract

Background: There is little consensus about the relative determinative value of each individual factor in female breast aesthetics. When performing breast surgery with an aesthetic goal, certain factors will be more important than others. The purpose of this study was to make an aesthetic factor rank list to determine the relative contributions to overall breast aesthetics. Method: Volunteers were scanned using the 3-dimensional Vectra system. Ten Scandinavian plastic surgeons rated 37 subjects, using a validated scoring system with 49 scoring items. The correlation between specific aesthetic factors and overall breast aesthetic scores of the subjects were calculated using Pearson’s r, Spearman’s ρ, and Kendall’s τ. Results: A very strong correlation was found between overall breast aesthetic score and lower pole shape (0.876, P < 0.0001). This was also true for upper pole shape (0.826, P < 0.0001) and breast height (0.821, P < 0.0001). A strong correlation was found between overall breast aesthetic score and nipple position (0.733, P < 0.0001), breast size (0.644, P < 0.0001), and breast width (0.632, P < 0.0001). Factors that were only moderately correlated with aesthetic score were intermammary distance (0.496, P = 0.002), nipple size and projection (0.588, P < 0.0001), areolar diameter (0.484, P < 0.0001), and areolar shape (0.403, P < 0.0001). Perceived symmetry was a weak factor (0.363, P = 0.027). Conclusions: Aesthetic factors of the female breast can be ranked in a priority list. Shape of the lower pole and upper pole and breast height are primary factors of female breast aesthetics. These should be prioritized in any aesthetic breast surgery. Vertical dimensional factors seem to be more determinative than horizontal factors.

Beyond the 21-cm Notch-to-nipple Myth: Golden Proportions in Breast Aesthetics

“…A wide range of brassiere sizes were used by the population. 12 The phi ratio was normally distributed for the left, right, and all breasts regardless of laterality. The average phi ratio was 1.596 ± 0.173 (95% confidence interval [CI] = [1.538, 1.653]) for the right breast and 1.594 ± 0.197 (95% CI = [1.529, 1.660]) for the left breast.…”

“…International differences have previously been shown when assessing breast aesthetics 25 and ratings in this study were performed by plastic surgeons who had practiced their whole career in Scandinavia. 12 A study with multiethnic raters would be needed to generalize the findings of this study.…”

“…This is evidenced by the fact that (1) unilateral Fibonacci breasts are rated more highly than unilateral 21-cm nipple-to-notch breasts; (2) symmetric pairs of Fibonacci breasts are rated more highly than symmetric 21-cm notch-to-nipple pairs; and (3) unilateral breasts that belong to symmetrical pairs do not score better than individually aesthetic breasts that do not belong to a symmetrical pair. 12 …”

“…This is evidenced by the fact that (1) unilateral Fibonacci breasts are rated more highly than unilateral 21-cm nipple-to-notch breasts; (2) symmetric pairs of Fibonacci breasts are rated more highly than symmetric 21-cm notch-to-nipple pairs; and (3) unilateral breasts that belong to symmetrical pairs do not score better than individually aesthetic breasts that do not belong to a symmetrical pair. 12 In a landmark study performed single-handedly by Penn 11 in 1954, the static 21-cm notch-to-nipple distance was introduced. In the study, 20 of 150 volunteers were selected for being "aesthetically perfect or nearly so."…”

“…These subjects were chosen based on small breast volumes that could tolerate virtual augmentation with natural results. 12 Inclusion criteria were female gender and age between 18 and 35 years. Exclusion criteria were congenital or acquired deformity of the breast or prior surgery of the breast.…”