Public Perception of Ideal Areola Proportions.

[BACKGROUND] In breast reconstruction, mastopexy, and breast reduction procedures, surgeons make decisions about the resulting areola size, and this significantly impacts the overall aesthetic result. Despite the importance of these decisions, little is known about the general population's preferences for areola size. The objective of this study was to survey the global population to better understand the public's perceptions of ideal areola dimensions.

[METHODS] A survey was developed with 9 different composite diagrams of a female torso (every combination of 3 breast widths and 3 waist widths). In each composite diagram, 6 different areola sizes were shown (areola-to-breast diameter ranging from 1:12 to 6:12). The survey was distributed via the Amazon Mechanical Turk digital platform, and respondents' demographics (sex, age, race/ethnicity, country, and state if located in the United States) and preferences for the most aesthetically pleasing size in each composite diagram were recorded.

[RESULTS] Among 2259 participants, with 1283 male (56.8%) and 976 female (43.2%), most participants were between 25 and 34 years old (1012, 44.8%), were from the United States (1669, 73.9%), and identified as White (1430, 63.3%). With 9 breast width and waist width combinations, the respondents were most likely to prefer the 2:12 (32.9%) areola-to-breast ratio ( P < 0.0001). The second most commonly preferred ratio was 3:12 (30.6%) ( P < 0.0001). Gender subgroup analysis showed that women preferred middle-range ratios, such as 2:12, 3:12, and 4:12 ( P < 0.0001). Meanwhile, men were more likely to prefer extreme ratios of 1:12 or 6:12 ( P < 0.0001). Across almost all races/ethnicities, 2:12 was significantly the most popular, except among American Indian/Alaskan Native and Middle Eastern where 3:12 was the most preferred ( P < 0.0001). Within the top 6 countries (United States, India, Brazil, Italy, Canada, United Kingdom), the United States, India, and Italy preferred 2:12, and Brazil, Canada, and the United Kingdom preferred 3:12 ( P < 0.0001).

[CONCLUSIONS] This study provides the first objective data on public impressions of the ideal areola proportions and can serve as a guide for surgical decision making in breast reconstruction and reshaping procedures.