Morphometric Analysis of Gender-affirming Breast Augmentation

Abstract

According to cisgender respondents, the "preferred" feminine breast has a 45:55 upper-to-lower pole ratio. Preferred breast ratios have not been evaluated for transgender women undergoing breast augmentation. Therefore, this study aimed to determine the preferred breast ratio according to the transgender population and, thus, better inform surgeon planning.

Methods: Patients diagnosed with gender dysphoria were sent a survey with morphed breast images of four different upper-to-lower pole ratios: 35:65, 45:55, 50:50, and 55:45. Respondents ranked the images according to aesthetic preference. Rankings were analyzed by the Condorcet method.

Results: 298 survey responses were analyzed: 197 (66.1%) respondents identified as transgender women and 31 (10.4%) as transgender men. Most respondents were younger than 40 (64.8%). Eighty-one (27.2%) had undergone breast augmentation, 136 (45.6%) had not and were not considering it, and 81 (27.2%) had not but were considering it. Across all subgroups, the most preferred ratio was 45:55 (P = 0.046). Those with more masculine genders and assigned female at birth preferred the 45:55 and 50:50 ratios equally. Those in their 30's and younger preferred the 45:55 and 50:50 ratios equally.

Conclusions: The 45:55 ratio, established as the most preferred morphometrics for breast augmentation by cisgender respondents, is also the most aesthetically preferred proportion among transgender patients. Interestingly, the 50:50 ratio, which projects a larger upper bust compared to the 45:55 ratio, may be equally or more appealing to younger patients and those with more masculine genders. We hope these results improve patient-physician shared decision-making and postoperative expectations.

Fig. 1.

Diagram of the upper to lower pole. From the top of the breast mound to the nipple is the upper pole. From the nipple to the inframammary fold is the lower pole. This is an original patient photograph and has not yet been morphed.

Fig. 2.

Randomized panel images for different upper-to-lower pole ratios. The upper-to-lower pole ratios are shown in the top left-hand corner of each panel. These ratios were replaced by letters (ie, A, B, C, and D) in the survey. This panel demonstrates a larger breast size.

Fig. 3.

Randomized panel images for different upper-to-lower pole ratios of a medium breast size. The upper-to-lower pole ratios are shown in the top left-hand corner of each panel. These ratios were replaced by letters (ie, A, B, C, and D) in the survey.

Fig. 4.

Randomized panel images of different upper-to-lower pole ratios of a smaller breast size. The upper-to-lower pole ratios are shown in the top left-hand corner of each panel. These ratios were replaced by letters (ie, A, B, C, and D) in the survey.

Fig. 5.

Randomized panel images of different upper-to-lower pole ratios of a larger breast size. The upper-to-lower pole ratios are shown in the top left-hand corner of each panel. These ratios were replaced by letters (ie, A, B, C, and D) in the survey.

Fig. 6.

Distribution of respondents by age and gender identity. Percentages are listed above each bar. *Years old.