Evidence Based Female Breast Aesthetics - Guidance for the Plastic Surgeon

The female breast is sometimes described as having a teardrop shape. How does one describe and measure the aesthetics of a teardrop shaped object and what makes the breast beautiful? By using subunits and three-dimensional images, 37 subjects were aesthetically rated by 10 surgeons. We found that the different subunits contribute differently to the overall aesthetic score. The findings were summed up in a priority list with Lower pole, Upper pole and Vertical height (LUV), being the most important factors. Aesthetic breasts have been regarded to have static measures. Females however come in all dimensions and one set of measures does not fit all. Our measures of the 3D scans were used to determine ideal proportions, thereby relating our findings to women of all different sizes. Using vertical height and width, we calculated the ratio and compared it to aesthetic score. The, in nature, frequently occurring Fibonacci ratio was associated with a higher overall aesthetic score. The average measures for a population have previously been used in cephalometrics to describe normal measures. The female breast does not lend itself to average measures in the same way that the face does, since there are more variations in measures of the breast. For this reason, proportional mammometrics will be of much more importance. Rating of aesthetics was different for different nations within Scandinavia. Although the number of raters was small, Danish surgeons were less likely to score high and Finnish surgeons were less likely to score low. To get satisfied patients, good communication is a requirement. Communicating even simple aspects of breast aesthetics, such as expectations of breast volume, can be a challenge. Brassiere size has historically been linked to breast reduction and breast size, since brassiere patterns have been an inspiration for breast reduction methods. Brassiere cup sizes are non-standardized measures. They are only meant for consumers to buy brassieres and not to be used for postoperative size predictions. We found that, the in clinic commonly used, brassiere cup size, was estimated by surgeons to be different from the cup size that was used by the subject. A low agreement was found. 3D technology may be a helping factor in the communication of breast aesthetics, likely also for other aesthetic factors than just breast size.