Study of identical twins reveals external factors that influence breast appearance, aging

Breastfeeding, daily moisturizing, hormone replacement found to decelerate perceived breast aging

September 4, 2012
American Society for Aesthetic Plastic Surgery (ASAPS)

Women wondering how to maintain great-looking breasts may now have more answers thanks to a new study of identical twin sisters. After controlling for genetic factors, investigators from University Hospitals Case Medical Center in Cleveland found that breastfeeding, daily moisturizing and hormone replacement therapy significantly decelerate the perceived aging of breasts. Smoking, drinking alcohol, multiple pregnancies, higher body mass index (BMI), and larger bra and cup sizes contribute to accelerated breast aging. The full results of the study, "Determinants of Breast Appearance and Aging in Twins," appear in the September issue of Aesthetic Surgery Journal.

"There appear to be several external factors that affect breast aging and appearance. The good news is that many of these factors can be controlled," said lead author Hooman T. Soltanian, M.D., of University Hospitals Case Medical Center and Case Western Reserve University School of Medicine in Cleveland, Ohio. "Identical twin studies like this one are very valuable because they allow us to control for genetic influences. This allows us to more accurately assess the impact of external factors on breast aesthetics, such as environmental and lifestyle factors."

161 pairs of female identical twins analyzed

Funded by a grant from the Aesthetic Surgery Education and Research Foundation (ASERF), the researchers recruited 161 pairs of identical female twins (mean age of 47.6 years) in 2009 and 2010 during the Twins Days Festival in Twinsburg, Ohio. Aesthetic breast features were subjectively rated in a blinded fashion by plastic surgery residents using standard medical photographs taken of the women's breasts.

The ratings were analyzed against data on participants' medical and personal histories to determine the significance of different external factors on breast appearance. The researchers found that, compared to their sibling counterparts, twins who moisturized their breasts daily had significantly fewer wrinkles in that area; those who received hormone replacement therapy after menopause had more attractive breast shape, size, projection, areolar shape and areolar size; and those who breastfed had less attractive areolar size and shape, but better skin quality. Unattractive breast ratings were associated with higher BMI, greater number of pregnancies, larger cup sizes, cigarette smoking and alcohol consumption.

Breast augmentation and breast lift procedures were among the top five most popular cosmetic surgeries for women in 2011, with 316,848 breast augmentations and 127,054 breast lifts performed, according to the American Society for Aesthetic Plastic Surgery (ASAPS).