To the editor of Archives of Plastic Surgery,
I read with great interest the article in your March 2015 issue: "A Consideration of Breast Imagery in Art as Depicted through Western Painting," authored by Kun Hwang et al. [[1]]. The authors are to be commended on their observations of how artists depicted the female breast. Unfortunately, it appears that the authors were a bit lax in their methodology concerning anthropomorphic measurements (AM). Although it may be true that the female chest is not distorted if there is less than 15 degrees of rotation, there will be distortion if the torso is also flexed or leaning to the side or both. There will also be distortion of the breast's position and shape in relationship to the bony landmarks of the chest if one or both arms are raised above 90 degrees. In addition, from my experience in AM of the breast, it is almost impossible to determine the position of the manubrium and mid-point of the clavicle in a photograph or painted image, and certainly if the torso is rotated, flexed or distorted. Furthermore, in the present article the authors elected to have only one author do all the measurements and calculations to remove 'bias', but perhaps this just added more bias to the results. Having reviewed the images studied by the authors, I find that ten subjects have their arms at greater than 90 degrees, most have their bodies flexed or leaning, in some of the subjects the artist painted them with an intentional body distortion and two subjects have no landmarks visible at all. At best, all calculations and subsequent results were made based on educated 'guesstimations' (guess+estimation). In addition, although the author's intent was just to study artistic renditions of the female breast, they did not attempt to correlate their findings with results of the reported clinical anthropomorphic studies [[2]
[3]
[4]]. Once again, I congratulate the authors for encouraging AM of the breast. I have always contended that if AM was a routine tool in aesthetic breast surgery, we would find that we could predict which anthropomorphic subgroups would experience excellent surgical results and which would be prone to complications and poor results. For those that are interested, I have gathered the paintings studied by the authors and they can be seen online in a Pinterest board I created: https://www.pinterest.com/fixer1254/anthropology-plastic/.
