Plastic Surgery Researchers Ask, 'What's the Perfect Breast?'
Ratio of 45:55 Has 'Universal Appeal,' Says Study in Plastic and Reconstructive Surgery

What's the perfect breast shape? Nearly everyone agrees—it's a breast with an "upper pole to lower pole ratio of 45:55," reports a study in the September issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"The 45:55 ratio has universal appeal in defining the ideal breast," concludes the report by plastic surgeons Dr Patrick Mallucci of The Cadogan Clinic and Dr Olivier Alexandre Branford of the Royal Free Hampstead NHS Trust, London. They believe this near-unanimity of opinion supports using the 45:55 ratio "as the basis for design in aesthetic surgery."

Study Seeks to Define Ideal Breast Proportions

The researchers performed a series of surveys to get people's opinions regarding the "aesthetic ideal of the breast." The surveys were conducted using photographs of the breasts of women with breasts of various sizes. Using Photoshop, the researchers altered the breast images, based on "key objective parameters."

The resulting images showed breasts of different proportions, based on the ratio of the upper to lower pole of the breast: 35:65, 45:55, 50:50, and 55:45. The level of the nipple marked the dividing line between the upper and lower poles. Thus in a breast with a 45:55 ratio, 45 percent of the breast would be above the nipple (upper pole) and 55 percent below the nipple (lower pole).

A population of 1,315 respondents were asked to rank the attractiveness of the breast images. Responses were compared for women versus men, for people of different ages, and in different racial/ethnic groups. The study also included ratings from 53 plastic surgeons.

The results were remarkably consistent, with all groups rating breasts with the 45:55 ratio as most attractive. The 45:55 ratio was favored by 87 percent of women in their thirties, 90 percent of men, and 94 percent of plastic surgeons.

The same ratio was also ranked highest by all racial/ethnic groups. Across groups, the 50:50 ratio was a distant second choice.

Study Questions 'Overfilled, Oversized' Look

Among women, there were some differences by age: 86 percent of women under 40 years old favored the 45:55 ratio, compared to 76 percent of those over 40. Dr Mallucci and colleagues write, "The more mature group [chose] more upper pole fullness, perhaps as a reflection of their own loss of projection over time."

Somewhat surprisingly, men as well as women, preferred the "more natural" 45:55 ratio. The researchers write, "This is in stark contrast to previously misplaced assumptions that men prefer oversized or 'fake' breasts—a view that has long been held as a clichéd interpretation of male preference." The findings also question the assumption that different cultural groups differ in their perceptions of breast appearance.

The results have important results for plastic surgeons planning breast augmentation, Dr Mallucci and colleagues believe. They write, "The desire for an overfilled and oversized look seems to have infiltrated practice without challenge in recent decades." They suspect that women who ask for a full upper pole are thinking of how they will look in clothing, rather than a more natural-appearing breast.

The researchers believe their results will help to define an "aesthetic template" for breast surgery—not just breast augmentation, but also breast lifting, breast reduction, and breast reconstruction. They are performing a clinical study based on surgical planning to achieve the "ideal" 45:55 ratio.

Meanwhile, they hope their results will serve as a "visual guide for both patient and surgeon…the end goal being to produce more acceptable, longer lasting results and ultimately more beautiful breasts."

Plastic and Reconstructive Surgery is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.