Bigger Bust No Longer on Trend: Malaysians Prefer Moderation in Ideal Female Breast Augmentation

Differential preferences in breast aesthetics by self-identified demographics assessed on a national survey

There is a paucity of literature examining how preferences differ amongst various demographic groups. This study aimed to assess how perceptions of the ideal breast differ between respondents stratified by self-identified demographic factors. A cohort of 25 patients from the senior surgeon's practice presenting for breast surgery was assembled. Pre-operative anteroposterior photographs of these patients were distributed via Qualtrics (Seattle, WA) to a large sample designed to be representative of the demographics of the United States. Survey questions aimed to measure respondents' impressions of 'breast attractiveness'. Respondents were asked to rate breasts on a Likert scale. Survey responses were analysed for differences in breast aesthetic preferences by sex, gender, sexual orientation, and race. Males rated all breasts higher on the Likert scale for attractiveness than females (2.8 vs 2.5, p < 0.001). Despite this discrepancy, ratings amongst male and female respondents were highly correlated with one another (R = 0.940; p < 0.0001). Considering sexual orientation, individuals attracted to women provided significantly higher attractiveness ratings to all breasts compared to individuals attracted to men only (2.8 vs 2.5, p < 0.001). White or Caucasian individuals ascribed significantly higher breast attractiveness ratings than Asian individuals (2.7 vs 2.2, p < 0.001), but not Black or African American individuals (2.7 vs 2.4, p = 0.23). Despite these racial discrepancies in mean breast attractiveness, ratings amongst the three groups were highly correlated. In a sample representative of the United States, a difference in breast aesthetic appraisal was observed by demographic factors. These findings merit further investigation to understand these trends and observations.

Updated trends of breast implant surgeries: An Israeli analysis

INTRODUCTION

Breast augmentation remains one of the most prevalent procedures in plastic surgery. While most patients experience high satisfaction with the outcomes, a subset may encounter various complications or dissatisfaction with achieved results necessitating subsequent surgical intervention including implant removal or exchange.

MATERIALS AND METHODS

We collected information from three pivotal private medical centers in Israel where a considerable number of breast surgeries are performed. We examined the number of breast augmentations, implant exchange and implant removal surgeries with or without breast lift that were performed on a biannual basis for each center for the period 2018-2022. Trends in surgery types were analyzed and compared to registries in other countries.

RESULTS

Between the years 2018 and 2022, 20,075 surgeries were done in three main private medical centers in Israel. Data show a gradual increase in implant removal surgeries from 2018 (n = 80, 2.9%) to 2019 (n = 269, 9.9%), followed by a significant increase in 2020 (n = 1436, 27.3%), and a gradual decline between 2021 (n = 1019, 22.8%) and 2022 (n = 916, 18.5%). The overall number of breast implant insertion procedures (breast augmentation procedures and exchange procedures) was 2659 in 2018 (97%), 2424 in 2019 (90.0%), 3816 in 2020 (72.6%), 3437 in 2021 (77.1%), and 4019 in 2022 (81.4%).

SUMMARY

We present updated trends in breast implant surgeries in Israel. 2020 was a key year in which the rate of explantations was the highest, and the percentage rate of implantations was the lowest and a year in which the trend changed. These patterns partly align with trends seen in other countries worldwide.

Cosmetic Surgery and the Diversity of Cultural and Ethnic Perceptions of Facial, Breast, and Gluteal Aesthetics in Women: A Comprehensive Review

An increasing number of people are opting for cosmetic surgeries. For many years, the physical and aesthetic appearance of Caucasians has been considered to be ideal. However, it is now commonly acknowledged that attractiveness and aesthetic standards vary among cultural backgrounds and ethnic groups and that Western attractiveness criteria no longer apply to all. Herein, we conducted a comprehensive review of studies that examined cultural and ethnic variations in preferences for facial, breast, and gluteal aesthetics, as well as reviewed studies that investigated ethnic disparities in attitudes and motivations for cosmetic surgery. A total of 4532 references were identified, 66 of which met the inclusion criteria. Several studies have reported that facial golden ratios are invalid for representing perceived attractiveness standards among different ethnicities. The majority of studies also indicated that facial aesthetic interventions should not aim to Westernize but to optimize ethnic traits. Significant ethnic differences in preferences for upper- and lower-pole breast proportions have been reported. The size of the buttocks and waist-to-hip ratio were identified as the main factors of buttock aesthetics, with buttock size preferences having a high ethnic diversity. Interest in cosmetic surgical procedures while maintaining ethnic identity continues to grow among young women worldwide. This comprehensive review strongly suggests that accommodating cultural and ethnic differences in aesthetic standards in cosmetic surgery planning can lead to more acceptable cosmetic outcomes.

Morphometric Analysis of Gender-affirming Breast Augmentation

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.