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The perfect breast: is it attainable? Does it exist?

While planning the program for the first breast symposium held in Santa Fe, New Mexico, in 1986, Harvey Zarem and I felt that a scholarly presentation on the aesthetics of that organ would keynote the underlying goal of all plastic surgery of the breast. Thus began a challenging search for such an expert. Surprisingly, a review of the anthropology and art literature resulted in a blank. It appeared that there had never been a scholarly anthropomorphic study or artistic analysis of the breast. Nor had there even been a valid statistical evaluation of the range and distribution of breast sizes and shapes. Telephone calls to the art and anthropology departments of several major universities did not result in anyone admitting to enough authority or interest to present the subject. Eventually I was referred to an unexpected source: the curator of costumes and fabrics at the Los Angeles County Museum, Dr. Edward Maeder. My call piqued his interest and resulted in a fascinating and scholarly presentation. His basic premise stemmed from his observation that the rendition of the nude female breast throughout the history of art reflected how the clothing of the specific time, place, and culture of any given historical era shaped the bosom. He presented a convincingly large number of examples. To underscore his point, he showed a slide of a sculptured nude that he had recently seen while visiting another museum. By merely looking at her breasts, he accurately placed the date and geographic origin of the piece! The plastic surgery literature is not, of course, devoid of articles on breast aesthetics. Many years ago, after measuring a series of student nurses, Jack Penn of South Africa determined that the ideal bosom described an 8to 81⁄2-inch equilateral triangle from the sternal notch to the nipples.1 (I must admit that my personal recollections of student nurses from the same long ago era as Jack Penn’s study suggested that they did not demonstrate such uniformity. I was perhaps a less objective observer.) John Tebbetts is currently the most vocal proponent of a formulaic algorithm for correct implant size and shape and has extensively proselytized the use of chest/breast ratios. He has repopularized the teardrop-shaped implant and has been instrumental in the design of the McGhan product. As we know, the face has been extensively measured and analyzed, and there are common basic dimensional relationships among features that have been considered attractive across time, cultures, race, and ethnicity. There are, however, no measurable aesthetic standards for the breast, undoubtedly due to its deformability from posture, arm position, and clothing. The breast is also the most changeable organ in the body, altering with puberty, weight gain and loss, hormonal balance, pregnancy, lactation, menopause, and just plain age. Just in the last hundred years, the idealized breast shape has gone from the Victorian “monobosom” to the boyish flapper to Jane Russell’s full-breasted look to today’s Pamela Anderson–like, contractured “Bay Watch” globules. While we surgeons bemoan our capsular contractures, the public hailed the advent of the Wonderbra, which was specifically designed to mimic the appearance of a Baker grade IV outcome. How many of our Hollywood starlets and fashion models proudly display their hemispherically augmented bosoms complete with full sternal separation incapable of contact cleavage? Today’s “hard body” aesthetic is 20 pounds lighter than that in the Jane Russell era, making the implant even more