Women’s breast types are classified according to volume, shape, position, and tissue structure. This diversity arises from genetic heritage and hormonal influences. In general, breast types are divided into basic forms such as round, teardrop (anatomical), conical, or athletic. In addition, breasts can also be described according to their placement on the chest, such as spaced, close-set, or wide-based. In clinical evaluations, asymmetry (differences in size and shape), ptosis (degree of sagging), and tubular (tuberous) breast are considered important structural deformities, each requiring a different approach.

What Are Women’s Breast Types – What Are the Breast Variations?

Women’s Breast Types - Breast Variations — Women’s Breast Types – Breast Variations

The breast structure of women may vary depending on genetic, hormonal, and environmental factors. This diversity is significant in both aesthetic surgery and health assessments. Breast types can be classified in terms of shape, symmetry, and volume. Here are the most common breast variations:

Round Breast

A type where both the upper and lower parts are equally full, generally symmetrical, and balanced in appearance. It is considered the most ideal type aesthetically.

Teardrop (Anatomical) Breast

Breasts that are fuller at the bottom and flatter at the top. They are frequently preferred in aesthetic surgery because of their natural appearance.

Asymmetric Breast

When one breast is noticeably larger or smaller than the other. A slight asymmetry is normal in most women.

Conical Breast

A type where the nipple projects prominently forward, while the breast base is narrower and conical in shape. It usually becomes apparent during puberty.

East Asian Type Breast

Smaller in volume, with a wide base and relatively flat structure. This is associated with genetic traits.

Sagging Breast

When breasts naturally sag downward due to aging, gravity, breastfeeding, or weight changes.

Side-Set Breast

Breasts with a wide space between them, oriented outward. Bra choice is especially important for this type.

Inverted Nipple Breast

A condition where the nipples are flat or inverted. It can be congenital or develop due to hormonal changes.

Bell-Shaped Breast

Breasts that are narrower at the top and wider at the bottom, resembling a bell. More common in larger breasts.

Athletic Breast

A type characterized by a muscular and flat chest with less fatty tissue. Often seen in athletes.

Small Breast

A type with less volume, a smaller breast diameter, and lower projection. It poses no health concerns.

Large Breast

Breasts with a high amount of fatty and glandular tissue. While it can be aesthetically desirable, it may also cause back and shoulder pain.

Tubular (Tuberous) Breast

A developmental form where the lower pole is narrow, the nipple and areola project forward, and the breast appears tube-shaped.

Large Nipple or Wide Areola Breast

A type characterized by a nipple or pigmented areola that is larger than normal. This may cause aesthetic concerns.

This diversity is entirely based on individual differences and is generally a natural condition. However, if significant changes are observed in the breasts, it is recommended to consult a specialist.

Is There Such a Thing as an Ideal Breast Shape?

Beauty perception undoubtedly varies from person to person, but in aesthetic surgery, there are some universal principles that guide us in achieving a harmonious and proportional appearance. Over the years, studies and observations have revealed that breasts considered aesthetically “attractive” share certain common characteristics. These features are not rules or obligations, but rather guidelines that help achieve natural and balanced results during surgical planning.

The foundation of this aesthetic ideal lies in the distribution of breast volume. Instead of a perfectly spherical breast or one that is excessively full at the top, the majority of natural breast volume is found in the lower half. Expressed in proportions: about 45% of the volume lies above the nipple level, while 55% is below. This 45:55 ratio gives the breast an elegant “teardrop” form. In this form, the upper part of the breast, or décolleté, begins with a soft and natural slope from the chest wall, far from an artificial “ball-like” appearance. Conversely, the lower half is full, firm, and rounded.

Other important elements that complete the aesthetic appearance are:

The nipple direction is slightly upward.
The nipple does not point directly forward or downward.
The décolleté has a flat or slightly concave transition.
The lower pole of the breast is full and convex.
There is no significant asymmetry between the breasts.
The breast base has a width proportional to the body.

Of course, these principles are not absolute truths for every woman. Nowadays, many women may prefer breasts with a fuller and rounder upper half. This is where modern aesthetic surgery plays its most important role: combining scientific aesthetic proportions with the patient’s personal desires and expectations. During preoperative consultations, it is crucial to go beyond general statements such as “I want it to look natural” and to understand what kind of cleavage and fullness is desired. This forms the foundation of both a successful outcome and patient satisfaction.

What Causes Breast Ptosis (Sagging) and What Are Its Types?

Breast sagging, medically called “ptosis,” is the downward displacement of the breast tissue and nipple over time due to the effect of gravity. This is one of the most common reasons why women seek aesthetic surgery. At its core, the problem stems from the weakening of the internal support structures that keep the breast elevated, similar to a hammock losing its tension. Several factors can lead to or accelerate this weakening:

The main causes of breast sagging include:

Aging
Long-term effects of gravity
Pregnancy and breastfeeding
Frequent and rapid weight fluctuations
Genetically weak connective tissue
Smoking
Large and heavy breasts

Each of these factors affects the breast’s internal structure differently. As we age, we lose collagen and elastin, the key proteins in the skin, which leads to looseness. The Cooper’s ligaments, which act as the breast’s “internal suspension system,” also lose elasticity. During pregnancy and breastfeeding, the dramatic increase and subsequent decrease in breast volume stretch the skin like a balloon inflating and deflating, leaving lasting laxity. Similarly, significant weight loss can reduce the fatty tissue inside the breast, leaving the skin loose. Smoking impairs blood circulation, reduces skin nutrition, and accelerates the aging process.

To objectively evaluate the degree of sagging and determine the appropriate treatment, a classification is used based on the nipple’s position relative to the inframammary fold (the crease where the breast meets the chest wall):

Grade I (Mild Ptosis): The nipple is at the level of the inframammary fold or up to 1 cm below it. There is usually mild upper breast emptiness and a general sense of looseness.
Grade II (Moderate Ptosis): The sagging becomes more noticeable. The nipple is clearly below the fold but has not yet reached the lowest point of the breast. Much of the breast tissue is below the fold.
Grade III (Severe Ptosis): The most advanced stage. The nipple is far below the fold, often at the lowest point of the breast, usually pointing downward. This almost always comes with significant skin excess.
Pseudoptosis (False Sagging): A common condition where the nipple is actually at or above the fold, but the breast tissue itself has descended. This results in the upper breast appearing empty and the lower part heavy. It is more a result of volume loss and tissue laxity than true sagging.

What Surgical Methods Are Used for Sagging Breasts?

Breast lift surgeries, medically known as “mastopexy,” aim to restore an aesthetic and youthful shape to sagging breasts. The main goals are to move the nipple to its ideal position, reshape the loose breast tissue, and remove excess skin. The surgical technique chosen depends directly on the degree of sagging. The objective is always to achieve the most effective and lasting result with minimal scarring.

Mild Ptosis (Grade I)

In cases of minimal sagging, techniques that leave the least scarring are preferred. The most common is the “Periareolar (Donut)” lift, where a ring of skin is removed around the areola. The incision is then tightened and closed, lifting the nipple by 1–2 cm. The scar is discreet because it lies at the border between the areola and normal skin. This technique is often combined with breast augmentation using implants, which enhance the results by providing fullness and additional lift.

Moderate Ptosis (Grade II)

As sagging becomes more pronounced, an incision only around the areola is not sufficient. The “Vertical (Lollipop)” lift is used here. In addition to the circular incision around the areola, a vertical incision runs from the bottom of the areola to the breast crease. This allows for more skin removal, higher nipple repositioning, and reshaping of the lower pole. The resulting scars resemble a lollipop, hence the name. A major advantage is the absence of a horizontal scar under the breast.

Severe Ptosis (Grade III)

In severe sagging cases with excess skin both vertically and horizontally, the “Wise-Pattern (Inverted T or Anchor)” lift is necessary. Along with the incisions of the lollipop technique, a horizontal incision is made along the inframammary fold. This allows maximum skin removal, nipple repositioning at any desired height, and complete reshaping of the breast tissue. While it leaves the most visible scars, it is the only technique that can effectively correct severe sagging.

Pseudoptosis (False Sagging)

In this situation, the main issue is not nipple position but loss of fullness in the upper breast. The treatment is usually breast augmentation with implants. Implants fill the empty upper portion, creating a natural “internal push-up” effect and giving the breast a fuller, lifted look.

Can Breast Augmentation and Lift Be Done in the Same Surgery?

Yes, this is quite common and, for many women, the most ideal solution. Especially after pregnancy or significant weight loss, when breasts have both lost volume and developed sagging skin, a combined “augmentation-mastopexy” – breast enlargement with implants plus a lift – is necessary. This surgery requires more complex planning than performing a lift or augmentation alone, because the surgeon must manage two opposing forces simultaneously: expanding the tissue from the inside with an implant and tightening the skin envelope from the outside.

One of the most critical decisions in these combined operations is whether the procedure will be performed in a single stage or two separate stages. This choice depends on the degree of sagging and the quality of the skin.

Single-Stage Surgery: In patients with mild to moderate sagging and relatively firm skin, both procedures can safely be performed together in one operation. The biggest advantage is that the patient undergoes anesthesia only once and has a single recovery period. However, this method carries certain potential risks:

Implant displacement downward (“bottoming out”)
Breast tissue sagging over the implant (“waterfall deformity”)
Early recurrence of sagging
Unwanted changes in implant position

These risks increase particularly when large implants are used or when skin quality is poor, since the tightened skin envelope is constantly struggling against the weight of the implant and gravity.

Two-Stage Surgery: For patients with severe sagging or weak skin elasticity, the safest and most predictable results are usually achieved through a two-stage approach. This strategy prioritizes long-term success.

First Stage: Only a breast lift (mastopexy) is performed. In this step, the nipple is repositioned to the ideal height, the breast tissue is reshaped, and all excess skin is removed.
Healing and Waiting Period: After surgery, a waiting period of at least 3 to 6 months is necessary for the tissues to heal, swelling to subside, the skin to adapt, and the breast to settle into its final shape.
Second Stage: At the end of this period, once the breast has stabilized and healed, a breast implant can be placed in a much simpler and shorter procedure.

This two-stage approach gives the surgeon maximum control over the final breast shape and implant position. It significantly reduces the risk of complications and provides more durable and aesthetically superior results. It is a strategic plan that, with patience, leads to more reliable outcomes.

What Is Tubular (Tuberous) Breast Deformity and Why Does It Require a Different Approach?

Tubular breast, also known as “tube breast,” “goat’s udder,” or “conical breast,” is a complex congenital developmental anomaly. It is not simply a matter of having “small breasts”; it involves a specific anatomical issue and therefore cannot be corrected with standard cosmetic procedures. In fact, inappropriate interventions without addressing the underlying problem – for example, placing only an implant – may worsen the deformity and make it more noticeable.

The main cause of this deformity is an abnormal, stiff, and inelastic ring of connective tissue at the base of the breast during puberty, where breast tissue normally develops and attaches to the chest wall. This ring acts like a clamp, preventing the breast tissue from expanding sideways and downward in a circular fashion. Under pressure, the breast tissue finds its only pathway to grow: outward through the nipple and areola area. As a result, instead of a rounded mound, the breast develops a narrow base and a tube- or cone-like shape.

Typical clinical findings of tubular breasts include:

The base where the breast meets the chest wall is narrow and constricted.
The lower half of the breast is underdeveloped and lacks tissue.
The areola is usually enlarged, swollen, and protruding forward.
The inframammary fold is higher than normal or poorly defined.
There is often noticeable asymmetry between the two breasts.

Correction of this deformity, though aesthetic in intention, is essentially a reconstructive surgery. The goal is not just to add volume but to rebuild the entire architecture of the breast. If the tight ring is not released first and an implant is placed directly, the implant may remain high under the chest muscle while the constricted breast tissue continues to hang below it. This leads to the so-called “double bubble” or “Snoopy” deformity, which is highly undesirable cosmetically.

Therefore, correction of tubular breasts requires a multi-step surgical strategy that addresses each anatomical problem individually. The essential steps of treatment are:

Releasing the Constricting Ring: This is the most critical step. Through an incision around the areola, the surgeon enters beneath the breast tissue and performs multiple radial incisions to completely release the tight ring. This allows the constricted tissue to “breathe” and spread naturally across the chest wall.
Expanding the Lower Pole: The deficiency of skin and tissue in the underdeveloped lower half must be corrected. The released breast tissue is redistributed to this area, and, if necessary, supported with additional methods such as fat grafting.
Adding Volume: Tubular breasts are almost always small. The missing volume is restored with anatomical (teardrop-shaped) implants or fat grafting. The implant provides both volume and structural support for the newly formed base.
Correcting the Areola and Inframammary Fold: Finally, the enlarged and protruding areola is reduced, and its bulging corrected. The high inframammary fold is surgically repositioned and fixed at the proper level.

What Solutions Exist for Breast Asymmetry?

No half of a woman’s body is a perfect mirror image of the other. Therefore, slight differences in breast size, shape, or position are completely normal and common. However, when these differences are visibly pronounced and negatively affect clothing choice, posture, or self-confidence, the condition is called “breast asymmetry,” which can be corrected surgically. Asymmetry correction is one of the most artistic and personalized areas of aesthetic surgery, since the goal often involves applying different procedures to each breast in order to create a balanced and harmonious whole.

Asymmetry can arise from many causes, ranging from developmental differences during puberty to changes after pregnancy and breastfeeding, or congenital conditions such as Poland syndrome. The treatment plan is shaped by the type of asymmetry and, most importantly, the patient’s desires.

The key question during planning is a simple but guiding one asked during consultation: “Which breast do you prefer?” The answer serves as the foundation for the entire surgical strategy. The “preferred breast” becomes the aesthetic target and template. All interventions on the other breast – reduction, augmentation, lifting, or combinations – are planned to match the preferred breast’s size, shape, and position. This patient-centered approach ensures the most satisfying, individualized result rather than imposing the surgeon’s own “ideal.”

Surgical options are determined according to the patient’s ultimate goal:

Goal: Smaller and Symmetrical Breasts

If the patient is generally dissatisfied with her breast size and prefers the smaller breast as a reference, the solution is to reduce the larger breast. If both are larger than desired, both can be reduced, but more tissue is removed from the larger side to achieve symmetry.

Goal: Larger and Symmetrical Breasts

If the patient desires a fuller appearance and prefers the larger breast as the goal, the smaller breast is augmented. This can be achieved using implants of different sizes depending on the volume difference, or by fat grafting (transferring fat from another body area to the smaller breast). Sometimes, different-sized implants are placed in both breasts for the best result.

Goal: Content with Current Volume, but Correcting Shape and Position

Sometimes the issue is not volume but differences in sagging or nipple height. In such cases, the solution is a breast lift (mastopexy). For the best symmetry, an “asymmetric mastopexy” is often performed, where different amounts of skin are removed from each side and the tissue is reshaped differently.

In many cases, asymmetry includes both volume and positional differences. Combined procedures are required for the best results. For example, in a patient with one large, sagging breast and one smaller, less sagging breast, a reduction and lift can be performed on the larger side, while augmentation with an implant and a lift can be performed on the smaller side in the same session. This illustrates how highly individualized and versatile asymmetry correction surgery must be.

Dr. Erman Ak

Op. Dr. Erman Ak who is one of the best cosmetic and plastic surgeon in Turkey, completed his specialization at Istanbul University Çapa Medical Faculty. He received advanced microsurgery training in Taiwan and, as an ISAPS fellow in Italy, training in facial and breast aesthetics. Dr. Ak holds the European Union Aesthetic Plastic Surgery qualification certificate from EBOPRAS and contributed to the establishment of the Plastic Surgery Department at Başakşehir Çam and Sakura Hospital. He currently accepts patients from Turkey and various other countries at his clinic in Nişantaşı.