Aesthetics of the Female Breast: Correlation of Pluralistic Evaluations with Volume and Surface Area

Abstract

The goal of cosmetic and reconstructive breast surgery is to fashion symmetric breasts with aesthetically acceptable shapes. Breast shape is largely determined by volume of tissue and surface area of the skin envelope. Values for breast surface area have never been published in the literature. The investigators developed an inexpensive, non-invasive optical method to objectively measure breast volume and surface area. The aims were to validate the method, to assess the accuracy of visual inspection by plastic surgeons, to determine ideal anthropomorphic measurements, and to derive a mathematical relationship between volume and surface area for an aesthetically acceptable shape. In the novel method, an optical grid was projected onto each breast and two images were captured in order to create a computerized three-dimensional model from which volume (V), surface area (A), and maximum vertical projection (Z) were calculated. The method was used to measure volume and surface area of the breasts of female volunteers. Anthropomorphic measurements were also recorded. Images of their breasts were arranged into a computerized survey, and plastic surgeons, cosmetic patients, and reconstructive patients were interviewed for aesthetic feedback. The method was validated on geometric shapes and female breasts. Simple geometric shapes (n = 22) were analyzed, and the actual V, A, and Z were compared with the imaged values using least-squares linear regression. There was excellent correlation in all three parameters (R \u3e 0.995, p \u3c 1014). The mean differences in V, A, and Z were 28 ± 28 mL (mean ± SD), 2 ± 9 cm2, and 0.4 ± 0.5 cm, respectively. Female breasts (n = 14) were analyzed, and the actual V and A were measured using plaster casts. Based on least-squares linear regression, there was excellent correlation between the imaged values and actual values (R \u3e 0.992, p \u3c 1011), and the mean differences in V and A were 32 ± 22 mL and 3 ± 11 cm2, respectively. The breasts of 109 female volunteers were measured and included for aesthetic evaluation. 252 plastic surgeons, 15 cosmetic patients, and 25 reconstructive patients submitted totals of 3,641, 368, and 437 evaluations, respectively. On average, plastic surgeons underestimated volume by 7% ± 49% (mean ± SD) and overestimated surface area by 15% ± 69%. Ideal anthropomorphic measurements and volume to surface area ratios were calculated and compared to previously published values. Cosmetic patients were most attentive to insufficient cleavage, and reconstructive patients were most attentive to severe asymmetry. For the first time, an optical method was demonstrated to measure volume and surface area with accuracy. When applied to the breast, measurement errors were small and clinically insignificant. Plastic surgeons were more accurate in estimating volume than surface area, though showing significant inconsistencies in both parameters from one breast to the next. Ideal anthropomorphic measurements were similar among plastic surgeons and breast surgery patients. Reconstructive patients preferred higher volume to surface area ratios than plastic surgeons and cosmetic patients