Objective Standards and Subjective Preferences in Breast Aesthetics: A Scoping Review of the Ideal Breast

Breast aesthetic ideals are shaped by anthropometric proportions, cultural norms, observer characteristics, and patient-specific expectations, yet the literature remains heterogeneous, with studies using variable measurements, image stimuli, and rating methods. This scoping review aimed to map the current evidence on objective morphometric standards and subjective aesthetic preferences in breast aesthetics and identify recurrent determinants of perceived breast attractiveness. A review was conducted in accordance with PRISMA-ScR guidance. MEDLINE and Embase were searched from inception to 28 October 2024. Studies were eligible if they evaluated breast aesthetic preferences, eye-tracking, ideal breast morphology, nipple-areola complex (NAC) characteristics, anthropometric measurements, or lay/clinician perceptions of breast aesthetics. Forty studies were included, comprising 39 cross-sectional studies and one prospective cohort study. Thirty-one studies (77.5%) primarily addressed general population images or measurements, while nine (22.5%) focused on a specific breast surgery context: breast augmentation (n = 4), breast reconstruction or breast-conserving therapy (n = 4), and reduction mammaplasty (n = 1). Seven overlapping evidence domains were identified: anthropometric, morphometric, eye-tracking, gender-related, cultural/geographic, lay perspective, and physician perspective studies. Recurrent determinants included breast-to-body proportionality, upper-to-lower pole ratio, lower-pole contour, projection, NAC position, areolar dimensions, and symmetry. No single breast morphology was consistently preferred across all populations. These findings support the use of recurring aesthetic domains as a practical framework for patient-centred consultation and outcome assessment, while highlighting the need for future research incorporating three-dimensional evaluation, culturally diverse populations, and validated patient-reported outcomes.