Chromatic and Morphological Determinants of Nipple–Areola Complex Attractiveness in Caucasian European Women

Abstract

Both aesthetic and cancer-related surgery may affect the nipple-areola complex (NAC). The role of its color in aesthetic perception remains poorly understood. Given parallels with facial and genital skin, the aim of the study was to evaluate the contribution of chromatic properties, particularly vasculature-dependent skin redness, to the aesthetic perception of NAC. Standardized NAC images from 1,907 female photomodels were analyzed for morphologic and chromatic values. NAC redness was experimentally enhanced to generate 730 paired stimuli differing only in chromaticity. A total of 384 adults completed 39,149 forced-choice comparisons. Aesthetic preference for NAC features was modeled using hierarchical mixed-effects Bradley-Terry/logistic models. Posterior latent-scale variance decomposition quantified the contribution of measured NAC characteristics, and trial-wise PSIS-LOO cross-validation assessed predictive contribution. Experimentally increased NAC redness was associated with greater attractiveness (OR = 1.45, 95% CrI [1.35, 1.56]). Photomodel age was inversely associated with preference after adjustment for measured NAC characteristics (OR = 0.854, 95% CrI [0.776, 0.938]). Higher areola-to-nipple ratio, nipple retraction, and visible areolar wrinkling were associated with lower aesthetic preference, whereas greater nipple a* and areolar b* were associated with higher preference. NAC attractiveness is shaped not only by morphology but also by chromatic properties. Experimental enhancement of NAC redness increased the odds of preference. Increased nipple redness and areolar yellowness is positively associated with aesthetic perception, whereas wrinkling, nipple retraction, and a disproportionate areola-to-nipple size ratio is negatively associated with attractiveness. These findings support the consideration of color outcomes in reconstructive and aesthetic breast procedures, including NAC tattooing.