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Ferraz CCV, Guimarães PAMP, Felix GDAA, Kobashikawa AT, Mallucci P, Neto MS. Exploring the Ideal of Breast Beauty: A Morphometric Analysis Based on the Opinions of the Brazilian Population. Aesthetic Plast Surg 2024:10.1007/s00266-024-04184-x. [PMID: 38913201 DOI: 10.1007/s00266-024-04184-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/04/2024] [Indexed: 06/25/2024]
Abstract
Background The quest to identify parameters deemed optimal for breast aesthetics holds paramount significance in both aesthetic and reconstructive surgery. The definition of ideal breast beauty, however, is subject to cultural variations and diverse standards, necessitating a detailed understanding. Objective This study delves into the perspectives of the Brazilian population regarding the aesthetics of the female breast. Methods A selection of images portraying variations in the distribution of upper and lower pole ratios across four distinct proportion models (35:65, 45:55, 50:50, and 55:45) was presented to participants. Through a meticulously crafted questionnaire administered via Google Forms, respondents were tasked with identifying the images they deemed most beautiful and attractive. Comprehensive demographic data of the study participants were gathered and subsequently correlated with their group-specific opinions. Results A total of 3744 questionnaire responses were collected 228 of which were from plastic surgeons/residents. The average age was 35 years, with 55.3% being women. Notably, breasts featuring a ratio of 45:55 emerged as the consensus choice for the epitome of beauty, garnering preference from 73% of the general population, 68% of women, 78% of men, and an equal 78% of plastic surgeons. This preference was consistent across all regions of the country. Conclusion Breasts with a ratio of 45:55 were universally deemed the most aesthetically pleasing. Similarly, breasts with a 50:50 ratio of breast tissue emerged as the next preferred choice. These insights contribute valuable perspectives on aesthetic considerations in breast surgery within the unique cultural context of Brazil.Level of Evidence IV 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 www.springer.com/00266 .
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Affiliation(s)
- Camila Cristina Valério Ferraz
- Division of Plastic Surgery, Federal University of São Paulo, Rua Botucatu, 720 - 2nd floor, São Paulo, São Paulo, Brazil.
| | | | | | | | | | - Miguel Sabino Neto
- Division of Plastic Surgery, Federal University of São Paulo, Rua Botucatu, 720 - 2nd floor, São Paulo, São Paulo, Brazil
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2
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Boyd CJ, Bekisz JM, Hemal K, Sorenson TJ, Karp NS. Differential preferences in breast aesthetics by self-identified demographics assessed on a national survey. J Plast Reconstr Aesthet Surg 2024; 90:60-66. [PMID: 38364668 DOI: 10.1016/j.bjps.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/03/2023] [Accepted: 01/29/2024] [Indexed: 02/18/2024]
Abstract
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.
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Affiliation(s)
- Carter J Boyd
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Jonathan M Bekisz
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Kshipra Hemal
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Thomas J Sorenson
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Nolan S Karp
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA.
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Wiegmann AL, O’Neill ES, Sinno S, Gutowski KA. Aesthetically Ideal Breasts Created With Artificial Intelligence: Validating the Literature, Racial Differences, and Deep Fakes. Aesthet Surg J Open Forum 2024; 6:ojae006. [PMID: 38501038 PMCID: PMC10945710 DOI: 10.1093/asjof/ojae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
Background A female's breasts are integrally tied to her identity and sense of femininity. Despite extensive study of breast aesthetics, there is no discrete formula for the "ideal breast" to guide the aesthetic surgeon. Racial and cultural differences heavily influence preferences in breast morphology. Artificial intelligence (AI) is ubiquitous in modern culture and may aid in further understanding ideal breast aesthetics. Objectives This study analyzed AI-generated images of aesthetically ideal breasts, evaluated for morphologic differences based on race, and compared findings to the literature. Methods An openly accessible AI image-generator platform was used to generate images of aesthetically ideal Caucasian, African American, and Asian breasts in 3-quarter profile and frontal views using simple text prompts. Breast measurements were obtained and compared between each racial cohort and to that of previously described ideal breast parameters. Results Twenty-five images were analyzed per racial cohort, per pose (150 total). Caucasian breasts were observed to fit nicely into previously described ideal breast templates. However, upper-to-lower pole ratios, nipple angles, upper pole slope contours, nipple-areolar complex positions, and areolar size were observed to have statistically significant differences between racial cohorts. Conclusions Defining the aesthetically ideal breast remains a complex and multifaceted challenge, requiring consideration of racial and cultural differences. The AI-generated breasts in this study were found to have significant differences between racial groups, support several previously described breast ideals, and provide insight into current and future ethical issues related to AI in aesthetic surgery. Level of Evidence 5
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Affiliation(s)
- Aaron L Wiegmann
- Corresponding Author: Dr Aaron L. Wiegmann, 1725 W. Harrison St, POB Suite 425, Rush University Medical Center, Chicago, IL 60612, USA. E-mail: ; Instagram: dr.wiegmann
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Beyond the 21-cm Notch-to-nipple Myth: Golden Proportions in Breast Aesthetics. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3826. [PMID: 34712540 PMCID: PMC8547918 DOI: 10.1097/gox.0000000000003826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
Background The 21-cm notch-to-nipple distance has been accepted without academic scrutiny as a key measure in breast aesthetics. The Fibonacci sequence and phi ratio occur frequently in nature. They have previously been used to assess aesthetics of the face, but not the breast. This study aims to assess if the static 21-cm measure or the proportional phi ratio is associated with ideal breast aesthetics. Method Subclavicular-breast height and breast width were used to calculate the aesthetic ratio. Subjects were subsequently aesthetically rated. A one-sample t-test was used to determine if the ratio for each breast differed from phi. Breast scores with one, both, or no breasts were compared with an optimal phi ratio. Analysis of variance was performed. Tukey-Kramer adjustment for multiple comparisons was used when pairwise comparisons were conducted. Results Five subjects (14%) had bilateral optimal phi ratio breasts. Four subjects (11%) had one breast with an optimal phi ratio. Subjects with bilateral optimal phi ratios had significantly higher overall breast scores than those with only one optimal breast (Δ = 0.86, P = 0.025) or no optimal breast (Δ = 0.73, P = 0.008). Distance from optimal Fibonacci nipple position was moderately to strongly correlated with aesthetic score (-0.630, P = 0.016). No correlation was found between 21-cm notch-to-nipple distance and aesthetic score. Conclusion The bilateral optimal phi ratio is correlated with high overall aesthetic scores, as is the optimal Fibonacci nipple position. No correlation was found between 21-cm notch-to-nipple distance and overall aesthetic score.
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Hamzan MI, Sulaiman WAW, Ismail NN. Bigger Bust No Longer on Trend: Malaysians Prefer Moderation in Ideal Female Breast Augmentation. Indian J Plast Surg 2021; 54:321-326. [PMID: 34667518 PMCID: PMC8515344 DOI: 10.1055/s-0041-1734572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background
It is important to correctly determine the ideal female breast anatomy and aesthetic proportions in order to prepare for surgery and establish its goals. Leaving the preference to the operating surgeons alone might leave unsatisfactory results, which especially leads to reoperation, quite often in the aspect of breast dimension.
Methods
This study was conducted using an online graphic questionnaire. We attempted to seek male and female perspectives toward their preferred ideal female breast size for breast augmentation, in order to provide up-to-date data to assist breast surgeons in attaining satisfactory surgical results.
Results
Sixty males and 67 females participated in the study comprising Asian major ethnicities of Malay, Chinese, and Indian. Universally, 46.6% of men and 53.5% of women preferred 30 mm diameter for the most ideal nipple-areola complex (NAC) size. For the perfect bust, they generally favored size C and D cup (37.8% and 38.5%, respectively).
Conclusion
The majority of women seek natural breast beauty and the longing for an oversized look appears to have infiltrated practice but these assumptions have finally been challenged by these findings.
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Affiliation(s)
- Muhammad Izzuddin Hamzan
- Reconstructive Science Unit, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.,Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kota Bharu, Malaysia.,Surgical Department, Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia
| | - Wan Azman Wan Sulaiman
- Reconstructive Science Unit, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.,Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Nur Nadia Ismail
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Malaysia
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Anatomical Poems about the Breast (" Le Beau Tetin") and Anatomical Proportions. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3652. [PMID: 34235037 PMCID: PMC8225378 DOI: 10.1097/gox.0000000000003652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/28/2021] [Indexed: 12/02/2022]
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Hamzan MI, Wan Sulaiman WA, Ismail NN. Perception of the most perfect female breast shape among Malays, Chinese, and Indians community. J Plast Surg Hand Surg 2021; 56:30-37. [PMID: 33840334 DOI: 10.1080/2000656x.2021.1908313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Researchers have long tried to search for the 'perfect' aesthetic outcome of breast surgery. Although lots of anthropometric studies have been done, there is no consensus when dealing with harmony, abstract, and proportion that make up for its ideal shape. This study was convened via a survey to find the most perfect breast shape by assessing the upper pole contour and upper pole to lower pole ratio (UP:LP) preference among the Malays, Chinese, and Indians races. Hundred thirty-five individuals partook in this survey. Most of the participants generally preferred a more convex shape of upper pole contour with the Malay (50%) and Indian (35.7%) favored a more convex shape while the Chinese preferred it to be just slightly convex (42.8%). Single unmarried individuals (64.7%) significantly preferred a more convex upper pole contour (p = 0.018). The UP:LP ratio of 45:55 (p = 0.002) was the most significantly preferred proportion (37.8%) which largely comprised of the Chinese (51%), followed by Indian (21.6%) and Malay (19.6%). With these findings, using a controlled perception-preference method is a more preferred choice when describing an ideal breast shape as compare to an anthropometric measurement that might be less accurate. Therefore, breast and plastic surgeons alike need to look beyond the anthropometric numbers and should consider the other 'abstract' aesthetic shape which difficult to measure including the upper pole breast that has more convexity and the UP:LP ratio of 45:55 which showed to be the most aesthetically perfect form as agreed in the current works of literature.
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Affiliation(s)
- Muhammad Izzuddin Hamzan
- Reconstructive Science Unit, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Wan Azman Wan Sulaiman
- Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Nur Nadia Ismail
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
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Comparison of mastectomy and breast reconstruction outcomes using low thermal dissection versus traditional electrocautery: a blinded randomized trial. Breast Cancer Res Treat 2021; 188:101-106. [PMID: 33742323 DOI: 10.1007/s10549-021-06177-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION PlasmaBlade® is a thermal dissection device that may allow for improved perfusion of the mastectomy flap by limiting thermal injury. In this study we aim to compare the mastectomy flap perfusion using PlasmaBlade® versus traditional electrocautery. METHODS Patients undergoing bilateral mastectomy with immediate breast reconstruction were recruited. The right and left breasts of each patient were randomized to dissection with PlasmaBlade® or standard electrocautery. Randomization was performed using random sequences on the day of surgery and was blinded to the plastic surgeon. Mastectomy flap perfusion was assessed following completion of the mastectomy using intra-operative fluoroscopy and plastic surgeon review. Surgical site drainage and pain score were measured. Sign tests were employed to assess differences in perfusion and Wilcoxon paired test for the secondary outcomes. RESULTS Twenty patients were enrolled in the study with median age of 40.5 years and median BMI of 26 kg/m2. In 18 patients (90%), perfusion was assessed to be better on the side of the PlasmaBlade® dissection. Median daily drainage over a 7-day period was 51 cc (IQR 35-61) on the PlasmaBlade® side and 44 cc (IQR 31-61) on the control side. Median pain score on the PlasmaBlade® side was 4.0 (IQR 2.3-5.9) and 4.4 (IQR 2.9-6) on the control side. No skin necrosis was noted in either groups. CONCLUSION Use of PlasmaBlade® appears to be a safe and reliable technique to perform mastectomy and breast reconstruction with equivalent outcomes to traditional electrocautery. Although, mastectomy skin flap perfusion was rated better intra-operatively for the PlasmaBlade® group, both cohorts had comparable outcomes. ClinicalTrials.gov Identifier: NCT03711916 Level of Evidence: I (Randomized trial).
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9
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Aravind P, Siotos C, Bernatowicz E, Cooney CM, Rosson GD. Breast Reduction in Adults: Identifying Risk Factors for Overall 30-Day Postoperative Complications. Aesthet Surg J 2020; 40:NP676-NP685. [PMID: 32506130 DOI: 10.1093/asj/sjaa146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Breast reduction is a commonly performed procedure. Understanding the postoperative complication profile is important for preoperative planning and patient education. OBJECTIVES The authors sought to assess complication rates following breast reduction in females and identify potential risk factors. METHODS We assessed the records of the American College of Surgeons National Surgical Quality Improvement Program participant use files that include patients who underwent breast reduction for macromastia between 2005 and 2016. Relevant patient and postoperative data were extracted, and factors affecting complications were analyzed utilizing the logistic regression model. RESULTS We identified 20,001 women aged a mean 43.9 years who underwent breast reduction. The number of patients who developed ≥1 complication was 1009 (4.3%). Our adjusted analysis revealed that outpatient setting (odds ratio [OR] = 0.600) and performance of the surgery by the attending surgeon alone (OR = 0.678) were associated with lower odds, whereas higher body mass index (OR = 1.046) and smoking (OR = 1.518) were associated with higher odds for complications following breast reduction. Outpatient setting (OR = 0.317) was also associated with lower odds whereas smoking (OR = 1.613) and American Society of Anesthesiologists class were associated with higher odds of returning to the operative room. These findings were consistent in our subgroup analysis for wound-related complications. CONCLUSIONS Our study shows that patient characteristics such as smoking and body mass index may increase complication rates after breast reduction. Clinical factors such as inpatient setting may also increase risk of complications following breast reduction. It is critical to understand the effect of these factors to better predict postoperative outcomes and ensure thorough patient education.
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Affiliation(s)
- Pathik Aravind
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Charalampos Siotos
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL
| | - Elizabeth Bernatowicz
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gedge D Rosson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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10
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An Aesthetic Factor Priority List of the Female Breast in Scandinavian Subjects. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3173. [PMID: 33173686 PMCID: PMC7647653 DOI: 10.1097/gox.0000000000003173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/14/2020] [Indexed: 11/26/2022]
Abstract
There is little consensus about the relative determinative value of each individual factor in female breast aesthetics. When performing breast surgery with an aesthetic goal, certain factors will be more important than others. The purpose of this study was to make an aesthetic factor rank list to determine the relative contributions to overall breast aesthetics.
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Siotos C, Cheah MA, Karahalios A, Seal SM, Manahan MA, Rosson GD. Interventions for reducing the use of opioids in breast reconstruction. Hippokratia 2020. [DOI: 10.1002/14651858.cd013568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Charalampos Siotos
- Rush University Medical Center; Department of Surgery, Division of Plastic and Reconstructive Surgery; Chicago IL USA
| | - Michael A Cheah
- Johns Hopkins University School of Medicine; Department of Plastic and Reconstructive Surgery; 601 N. Caroline Street Baltimore MD USA 21287
| | - Amalia Karahalios
- Monash University; School of Public Health and Preventive Medicine; Melbourne Australia
| | - Stella M Seal
- Johns Hopkins University School of Medicine; Welch Medical Library; 2024 E. Monument St. Baltimore MD USA 21287
| | - Michele A Manahan
- Johns Hopkins University School of Medicine; Department of Plastic and Reconstructive Surgery; 601 N. Caroline Street Baltimore MD USA 21287
| | - Gedge D Rosson
- Johns Hopkins University School of Medicine; Department of Plastic and Reconstructive Surgery; 601 N. Caroline Street Baltimore MD USA 21287
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