Intercultural Differences In Aesthetic Breast Shape Preferences Amongst Plastic Surgeons

Goals/Purpose:

There has been little discussion in the plastic surgery literature regarding breast shape preferences amongst plastic surgeons or laypersons, despite strong evidence that aesthetic preferences are influenced by the age, gender, and cultural background of an individual. There are many differences in the way individuals define or recognize the criteria required for breasts to be considered attractive, and investigators are still working to better define objective criteria that might aid in this effort. This survey will provide a better understanding of the presence of such differences and how they are related to the individual's cultural background, sex, gender and personal experience with aesthetic surgery. The findings may have major implications for how patients both select and communicate with their plastic surgeon about their cosmetic or reconstructive needs. This survey project aims to increase awareness of the existing variations in the breast shape preferences amongst plastic surgeons around the world.

Methods/Technique:

We designed an interactive, online survey to assess the aesthetic breast shape preferences amongst plastic surgeons. Ranges of superior pole fullness and areola size in the natural and augmented breast were achieved via digital alteration in order to enable participants to change certain characteristics in the shape of a model's breasts. The three modifiable photographs were incorporated into a questionnaire that was translated into English, French, German, Portuguese, and Spanish in order to maximize international participation. Plastic surgeons were recruited by email correspondence through contact listings in national specialty societies. Demographic data about the surgeons participating in the survey were collected in conjunction with the breast shape preferences. We screened the data and found less than one percent to be missing.  In the interest of retaining data, we imputed the respective mean values.  Thereafter, Analysis of Variance (ANOVA) was used to elucidate differences for three indicators of breast shape preferences across nations, gender, ethnicity, practice type, age and surgeon experience.  Normality assumptions of the three indicators of breast shape preferences were met.    

Results/Complications:

We gathered a total of 612 responses from plastic surgeons practicing in 29 different counties. Significant differences in preference of ideal upper pole fullness [F(5, 606)= 5.94, p < .0001], areola size in the natural breast [F(5, 606)= 3.42, p = .005], and areola size in the augmented breast [F(5, 606)= 2.94, p = .012] were found among plastic surgeon nationalities. Breast shape preferences were not found to differ significantly across surgeons' self-reported ethnicity: upper pole fullness, F (5, 606) = 2.04, p=.07; areola size of the natural breast, F (5, 606) = .70, p=.62; areola size of the augmented breast, F (5, 606) = .29, p=.92. Significant relationships were distilled between age and breast shape preferences. The surgeon's age was negatively correlated with perceptions of ideal upper pole fullness, r  = -.11, p=.006, suggesting that older surgeons reported preference for less upper pole fullness.  This pattern was reversed for ideal areola size of the natural and augmented breast. Specifically, older surgeons expressed a preference for a larger areola size in both the natural breast (r = .20, p=.000) and augmented breast (r=.14, p=.001). No significant differences in breast shape preferences were found across surgeon gender, practice type (academic vs. private), or surgeon experience. However, several additional interesting preference correlations were elucidated when we considered multiple factors in combinations, such as the effect of gender, nationality, and practice type together on aesthetic breast shape preferences amongst plastic surgeon participants.

Conclusion:

Based on our findings, nationality and age appear to dramatically impact the breast shape preferences of plastic surgeons practicing around the globe. Whether these differences are a function of surgical training geography and mentorship, a reference point for the preferences of patients seeking surgery in the practice, or simply the personal aesthetic preferences of the surgeons performing breast augmentation or reconstruction procedures, these findings could have very significant implications for both patients seeking and surgeons performing cosmetic and reconstructive breast surgery. In an increasingly global environment, and especially with the advent and growth of medical tourism, cultural difference and international variability must be considered when new techniques and aesthetic outcomes are being defined and published. The breasts are extremely important to the patient and challenging to the surgeon. When both the plastic surgeon and the patient are able to adequately and effectively communicate about their breast shape preferences, they will be more successful at achieving satisfying results.