In Search of the Attractive Breast

There have been many descriptions of attractive breasts, but few have defined what exactly creates an attractive breast, especially after augmentation mammaplasty. The age-old adage, “beauty is in the eye of the beholder,” may be true; however, there are several characteristics of an attractive breast that are similar despite the size or shape of the breast. It is odd that we have spent so much time and effort in developing techniques for breast surgery without a paragon for identifying what exactly are the factors that define an attractive breast. To discover the characteristics of the attractive breast, a Google (Mountain View, CA, USA) and PubMed (U.S. National Institutes of Health’s National Library of Medicine, Bethesda, MD, USA) search was performed and defined the attractive breast mostly by size. One study showed that medium to large sizes were found to be more attractive, especially in the oblique view.¹ In 2012, Mallucci studied 100 consecutive “non-augmented” topless models in a three-quarter pose that had been chosen for the attractiveness by the editors of a British mass print media magazine. His findings were that the most attractive breasts, in an oblique view, had an upper pole to lower pole ratio of 45:55, the nipple points upwards at 20 degrees, lower pole convexity, and upper pole concavity.² The authors believe that there are some subtle differences in the appeal of breasts which are augmented vs those that are not. Most recently, the same author ranked images of 4 females based on the upper pole to lower pole proportions and found that the same 45:55 ratio was rated as the most attractive by 1315 respondents.³

After 26 years in practice and conservatively over 5000 breast consultations, the senior author has found that the same 10-15 breast pictures in an anteroposterior view were picked as “attractive” over and over by his patients (Figure 1). What did these breasts have in common? A large print of these breasts was rendered, several measurements were made, and the proportions were observed. Indeed, all the pictures had something in common with proportions similar to a Fibonacci ratio. These breasts ranged from large “B” cups to “D” cups and from 1/5 in roundness to 5/5 in roundness (Figure 2).⁴ When the distance from the clavicle to the top of the breast mound along the breast meridian and compared it to the top to bottom distance of the breast (breast to chest ratio), the most attractive breasts had a mean of 67% with a range of 64%-74%. Another proportion that became apparent was that the most attractive nipple position from medial to lateral edge of the breast (horizontal nipple position [HNP]) was a mean of 71% with a range of 60%-80%. The height of the nipple from the bottom to the top of the breast mound (vertical nipple position [VNP]) was a mean of 43% with a range of 38%-47% (Figure 3). This represents the inverse of the Mallucci upper pole to lower pole ratio. This is expected compared with Mallucci’s proportions in that an augmented breast would have proportionally more upper pole fullness. These proportions held true for primary breast augmentations, augmentations with mastopexy, and revisionary breast surgery. One of the problems with the Mallucci paper is that it suffers from a common problem associated with the current photograph morphing programs. When you morph the breast mound up or down, it can make the breast appear unnatural, unattractive, and/or odd (Figure 4); therefore, the only picture that looks good is the one that was not actually morphed. It does not necessarily mean that a 55:45 upper pole to lower pole ratio is unattractive. It only would look unattractive if the nipple position was improper due to the morphing process.

Figure 1.

Examples of the most requested postoperative breasts by the senior author’s patient population: (A) a 26-year-old female, (B) a 36-year-old female, (C) a 37-year-old female, and (D) a 31-year-old female. BCR, breast to chest ratio; HNP, horizontal nipple position; VNP, vertical nipple position.

Figure 2.

Breast shape classification.

Figure 3.

Breast proportions that were rated highest by the senior author’s patient population. BCR, breast to chest ratio; HNP, horizontal nipple position; VNP, vertical nipple position.

Figure 4.

(A-D) The nipple position’s effect on breast aesthetics. This figure was reprinted with permission from Wolters Kluwer.³

As a check to confirm that these breast measurements would be consistent with generally perceived “attractive” breasts outside of the senior author’s practice, a nude picture of Carmen Electra, who is generally considered to have attractive breasts, was printed and the same measurements were calculated: the vertical breast to chest proportion was 64%, the HNP was 73%, and the VNP was 42%. These appear to be consistent with the above measurements.

This study is limited by a single surgeon’s patient population and perspective on what constitutes an attractive breast. All breast augmentations were performed with round implants which are known to increase superior pole fullness and convexity. Additionally, slight differences in camera angles can change the apparent proportions as well; however, all photographs are standardized at the senior author’s office to ensure that there is no discrepancy in angles or proportions.

Boone Pickens, the famous oilman from Texas, once said that “an idiot with a plan beats a genius without a plan all day long.” In performing breast surgery, many surgeons have a vision for the perfect breast because they inherently know what looks attractive but may not be able to define it. Having a definite knowledge of what proportions create an attractive augmented breast will help the surgeon develop a better plan. Regardless of whether the patient desires to be small or large, natural appearing or have a “fake,” round appearance, a clearly defined plan will improve an individual’s results and ultimately result in a happier patient.

Disclosures

The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The authors received no financial support for the research, authorship, and publication of this article.