Defining the Ideal Reduction Mammaplasty: A Crowdsourcing Study.

Background: Reduction mammaplasty relieves macromastia symptoms while improving breast aesthetics, although the ideal breast aesthetically has been shown to differ culturally in previous crowdsourcing studies. Better understanding these differences can aid in setting postoperative expectations.

Objectives: The aim of this study was to characterize the ideal reduction mammaplasty according to demographics such as gender, ethnicity, socioeconomic status, and education.

Methods: A crowdsourcing platform was utilized to collect 10,169 deidentified responses. Users completed 1 of 3 surveys, either a preoperative, postoperative, or preoperative and postoperative paired survey. The preoperative and postoperative surveys addressed 10 breast measurements, including upper breast slope, projection proportion, nipple position, breast width, and breast fullness. The paired preoperative and postoperative survey assessed the nipple-areola complex (NAC), chest fit, symmetry improvement, and scarring.

Results: Preoperative images were rated more aesthetic than postoperative images. This was consistent across all demographics evaluated. Females, African Americans, Asians, participants ages 55+, and participants with no high school degree or a graduate degree found the most improvement in breast symmetry (P = .001, P = .002, P = .027, P < .001, P = .01). Male and Hispanic participants were most likely to see no change in symmetry (P = .008, P = .04), and South Asian participants found breasts less symmetric postoperatively (P < .001). There were significant demographic differences in aesthetic ratings of the NAC, scarring, and breast fit.

Conclusions: Perceived breast aesthetics after reduction mammaplasty vary significantly across demographics, including gender, ethnicity, age, socioeconomic status, and educational achievement. Surgeons should consider demographics when planning each patient's reduction mammaplasty.