Morphometric Analysis of Gender-affirming Breast Augmentation.

Area of Science:

• Plastic Surgery
• Aesthetics
• Gender Affirming Care

Background:

• The preferred breast morphology for cisgender women undergoing augmentation mammoplasty is a 45:55 upper-to-lower pole ratio.
• Aesthetic preferences for breast augmentation among transgender women have not been extensively studied.

Purpose of the Study:

• To determine the preferred breast upper-to-lower pole ratios among transgender individuals seeking breast augmentation.
• To provide data to inform surgical planning and improve patient-physician shared decision-making.

Main Methods:

• A survey was distributed to patients diagnosed with gender dysphoria, presenting morphed breast images with four different upper-to-lower pole ratios (35:65, 45:55, 50:50, 55:45).
• Respondents ranked images based on aesthetic preference, with rankings analyzed using the Condorcet method.

Main Results:

• 298 responses were analyzed, with the majority identifying as transgender women.
• The 45:55 ratio was the most preferred across all subgroups (P = 0.046).
• Younger respondents (<40) and those identifying with more masculine genders equally preferred the 45:55 and 50:50 ratios.

Conclusions:

• The 45:55 upper-to-lower pole ratio is the most aesthetically preferred proportion for breast augmentation among transgender patients, consistent with cisgender preferences.
• A 50:50 ratio may be equally or more appealing to younger transgender individuals and those with more masculine gender identities.
• These findings can enhance shared decision-making and manage postoperative expectations in gender-affirming breast augmentation surgery.