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

Abstract

Background: The 21-cm notch-to-nipple distance has been accepted without academic scrutiny as a key measure in breast aesthetics. The Fibonacci sequence and phi ratio occur frequently in nature. They have previously been used to assess aesthetics of the face, but not the breast. This study aims to assess if the static 21-cm measure or the proportional phi ratio is associated with ideal breast aesthetics. Method: Subclavicular-breast height and breast width were used to calculate the aesthetic ratio. Subjects were subsequently aesthetically rated. A one-sample t-test was used to determine if the ratio for each breast differed from phi. Breast scores with one, both, or no breasts were compared with an optimal phi ratio. Analysis of variance was performed. Tukey–Kramer adjustment for multiple comparisons was used when pairwise comparisons were conducted. Results: Five subjects (14%) had bilateral optimal phi ratio breasts. Four subjects (11%) had one breast with an optimal phi ratio. Subjects with bilateral optimal phi ratios had significantly higher overall breast scores than those with only one optimal breast (Δ = 0.86, P = 0.025) or no optimal breast (Δ = 0.73, P = 0.008). Distance from optimal Fibonacci nipple position was moderately to strongly correlated with aesthetic score (−0.630, P = 0.016). No correlation was found between 21-cm notch-to-nipple distance and aesthetic score. Conclusion: The bilateral optimal phi ratio is correlated with high overall aesthetic scores, as is the optimal Fibonacci nipple position. No correlation was found between 21-cm notch-to-nipple distance and overall aesthetic score.

Patient and Plastic Surgeon Agreement on Bra Cup Size

“…Inclusion criteria for the study were women aged 18–35 years. Exclusion criteria included previous chest wall or breast surgery (Sandberg et al, 2023).…”

“…They combined cup sizes greater than DD and recorded them as DDD+. Using the Vectra System software, the researchers calculated the breast volume for each of the participants' breasts, combined the paired breast volume, divided it by 2, and used the average value to analyze volumes for each cup size (Sandberg et al, 2023).…”

“…The surgeons were asked to rate how comfortable they felt evaluating breast cup sizes using clinical examination, 2D (two-dimensional) photographs (i.e., flat photographs depicting length and breadth), and 3D scans (i.e., an image depicting length, breadth, and height) on a Likert scale (1–5). The researchers compared the participants' disclosed breast cup sizes with the cup sizes estimated by the surgeons (Sandberg et al, 2023).…”

“…They also used kappa statistics to calculate the agreement for each of the surgeon raters. They used Pearson correlation to determine whether surgeon age, gender, or time spent in practice correlated with the level of agreement (Sandberg et al, 2023).…”

“…Therefore, when plastic surgeons and nurses discuss a patient's anticipated breast cup size during the consultation, it can lead to miscommunication that can result in patient dissatisfaction and potential reoperations (Hidalgo & Spector, 2010). This Evidence Review column discusses a study by Sandberg et al (2023) conducted to determine the correlation between the patient's desired breast cup size and the final breast cup size estimated by the plastic surgeon using three-dimensional (3D) images.…”