BACKGROUND: There is little consensus about the relative determinative value of each individual factor in female breast aesthetics. When performing breast surgery with an aesthetic goal, certain factors will be more important than others. The purpose of this study was to make an aesthetic factor rank list to determine the relative contributions to overall breast aesthetics. METHOD: Volunteers were scanned using the 3-dimensional Vectra system. Ten Scandinavian plastic surgeons rated 37 subjects, using a validated scoring system with 49 scoring items. The correlation between specific aesthetic factors and overall breast aesthetic scores of the subjects were calculated using Pearson's r, Spearman's ρ, and Kendall's τ. RESULTS: A very strong correlation was found between overall breast aesthetic score and lower pole shape (0.876, < 0.0001). This was also true for upper pole shape (0.826, < 0.0001) and breast height (0.821, < 0.0001). A strong correlation was found between overall breast aesthetic score and nipple position (0.733, < 0.0001), breast size (0.644, < 0.0001), and breast width (0.632, < 0.0001). Factors that were only moderately correlated with aesthetic score were intermammary distance (0.496, = 0.002), nipple size and projection (0.588, < 0.0001), areolar diameter (0.484, < 0.0001), and areolar shape (0.403, < 0.0001). Perceived symmetry was a weak factor (0.363, = 0.027). CONCLUSIONS: Aesthetic factors of the female breast can be ranked in a priority list. Shape of the lower pole and upper pole and breast height are primary factors of female breast aesthetics. These should be prioritized in any aesthetic breast surgery. Vertical dimensional factors seem to be more determinative than horizontal factors.