The Search for the Ideal Female Breast: A Nationally Representative United-States-Census Study

Abstract

Introduction: Many studies have started to search for the perfect aesthetic breast in order to create a pars-pro-toto for reconstruction, but especially for aesthetic surgery. To date, no representative study with anatomically accurate models was performed.

Methods: In an online based United-States-census-representative survey with 1049 participants, questions regarding the preferred breast were asked utilizing lifelike morphed 3D-generated female models for the first time. Attributes such as breast pole ratio, areola size, breast direction and projection were asked.

Results: The results show that, contrary to what has been claimed in previous studies, an upper-pole-to-lower-pole ratio of 55:45 is preferred by both female and male participants. When it comes to breast size, on the other hand, there are clear gender-specific differences. While women opted for a cup size around B, the men preferred larger cup sizes. Moreover, the smallest depicted areola size of 30 mm was favored among all groups in the survey.

Discussion: Most publications used rather detrimental models for their surveys. We therefore opted for computer-generated 3D models and varied their naturalness. This enabled us to ensure a more aesthetic and accurate illustration and thus obtained more comparable and reliable results paired with the representation of the US-population. Taken together this study unveiled unexpected insights into the population favored breast attributes that might change operative planning in breast surgery.

Level of evidence v: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Keywords: Female; Ideal breast; Morphometry.

Fig. 1

Survey results on the preferred breast ratio and projection. A In the survey 1012 participants responded to the question what ratio of the breast poles is preferred. 532 female and 471 male participants responded. With 28.5% the majority of the overall population prefer a ratio of 55:45 between the upper and the lower pole. Differentiating between male and female participants, there is no change in this trend upon the subgroups. B In the survey 996 participants responded to the question what percentage of the upper pole projection compared to the initial image is preferred. 528 female and 468 male participants responded. In the ¾-view there is an overall trend towards upper pole projection. There is a divergence in preference between men and women in both the ¾-view and the side-view. Women significantly prefer an increased upper pole projection, while men show no preference. This diverging correlation is significant in both views (p = 0.05). For correlation between two bivariate nominal values Phi and Cramer-V test were performed. For comparing two single values two-sample t-test was performed. p value: * < 0.05

Fig. 2

Survey results on preferred areola diameter and nipple-to-nipple distance. A In the survey 1000 participants responded to the question what areola diameter is preferred. 529 female and 471 male participants responded. With 23.5% the majority of the overall population prefer the smallest areola-size of 30 mm. With larger areola the preference decreases. Differentiating between male and female participants, there is no change in this trend upon the subgroups. B In the survey 994 participants responded to the question what distance between the nipples is preferred. 526 female and 468 male participants responded. In the ¾-view there is an overall trend towards narrow breasts with 210 mm distance. There is a divergence in preference between men and women in the frontal view. Women prefer a significantly narrower breast while men show no specific preference. This diverging correlation is significant in the frontal view (p = 0.03). For correlation between two bivariate nominal values Phi and Cramer-V test were performed for two bivariate ordinal Kendall-Tau-B. For comparing two single values two-sample t-test was performed. p value * < 0.05

Fig. 3

Survey results on preferred breast cup size. A In the survey 989 participants responded to the question what breast cup size is preferred. The breast cup sizes were calculated by the difference between bust and underbust circumference according to the EN 13402. 525 female and 464 male participants responded. In the 3/4 -view breasts larger than A cups are preferred. The vast majority of the female participants preferred B-cup breasts. Differentiating between male and female participants, there is general tendency for men to prefer larger breasts than women. This trend is also shown in the frontal view. This diverging correlation is significant both in the ¾-view (p < 0.001) and the frontal view (p = 0.004). For correlation between two bivariate nominal values Phi and Cramer-V test were performed. For comparing two single values two-sample t-test was performed. p value: * < 0.05

Fig. 4

Survey results comparing the groups of participants who had aesthetic surgery done on their breast and participants who would like to change their breast surgically of aesthetic reasons. A Two groups of totally 425 participants were compared based on their response to the question of whether they had ever had aesthetic breast surgery or never had any aesthetic procedure done. The breast cup sizes were calculated by the difference between bust and underbust circumference according to the EN 13402. The response to the preferred breast cup size showed a significant tendency towards larger breasts in participants who had pervious breast augmentation. This correlation was shown in 3/4 -view (p = 0.05) as well as in the frontal view (p = 0.026). For the question whether the female participants would surgically change their breast because of aesthetic reasons 525 responses were collected. Participants who would want surgically change their breast because of aesthetic reasons tend to prefer larger breast sizes in the ¾-view (p < 0.001) and front view (p = 0.03). B The same groups were compared for their response to the preferable ratio of the breast poles. There was no statistically significant correlation detectable in either group. C The same groups were compared for their response to the preferable areola diameter. Female participants who had surgically augmented their breast prefer smaller areola diameter (p = 0.003), while there is no significant correlation between the question whether they would surgically change their breast because of aesthetic reasons and the areola diameter preference. For correlation between two bivariate nominal values Phi and Cramer-V test were performed for two bivariate ordinal Kendall-Tau-B. For comparing two single values two-sample t-test was performed. p value: * < 0.05

Fig. 5

Illustration and overview of attribute preferences in breast according to men and women