American Society for Aesthetic Plastic Surgery Releases a Study: Twins’ Breasts Are Revealing

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Identical twin study uncovers external factors that influence breast appearance and aging.

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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, whereas 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 the 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, MD, 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.”

Funded by a grant from the Aesthetic Surgery Education and Research Foundation (ASERF), the researchers recruited 161 pairs of identical female twins (mean age: 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 appearance is incredibly important for women. This study is significant because it clearly shows women what they can do right now to help slow the aging process and keep their breasts looking attractive, even without surgical intervention,” said Foad Nahai, MD, Editor-in-Chief of Aesthetic Surgery Journal.

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).


The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; active members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and non-surgical aesthetic procedures. International active members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.

The Mission of The Aesthetic Surgery Education and Research Foundation (ASERF) is to demonstrate the effectiveness and safety of cosmetic plastic surgical procedures, devices, and techniques by funding directed and physician-initiated research and sharing this cutting edge knowledge. ASERF helps to make new treatments with proven benefits more widely available to patients who seek to improve their quality of life through aesthetic surgery and cosmetic medicine procedures. ASERF is a 501(c) (3) charitable foundation. For more information, visit

About ASJ
The Aesthetic Surgery Journal is the peer-reviewed publication of the American Society for Aesthetic Plastic Surgery (ASAPS) and is the most widely read clinical journal in the field of cosmetic surgery, with subscribers in more than 60 countries

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Adeena Babbitt or Ashley Barton
Amer Soc for Aesthetic Plastic Surgery
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