Abstract
Background Breast aesthetics evaluation often relies on subjective assessments, leading to the need for objective, automated tools. We developed the Seoul Breast Esthetic Scoring Tool (S-BEST), a photometric analysis software that utilizes a DenseNet-264 deep learning model to automatically evaluate breast landmarks and asymmetry indices. Methods S-BEST was trained on a dataset of frontal breast photographs annotated with 30 specific landmarks, divided into an 80-20 training-validation split. The software requires the distances of sternal notch to nipple or nipple-to-nipple as input and performs image preprocessing steps, including ratio correction and 8-bit normalization. Breast asymmetry indices and centimeter-based measurements are provided as the output. The accuracy of S-BEST was validated using a paired t -test and Bland-Altman plots, comparing its measurements to those obtained from physical examinations of 100 females diagnosed with breast cancer. Results S-BEST demonstrated high accuracy in automatic landmark localization, with most distances showing no statistically significant difference compared with physical measurements. However, the nipple to inframammary fold distance showed a significant bias, with a coefficient of determination ranging from 0.3787 to 0.4234 for the left and right sides, respectively. Conclusion S-BEST provides a fast, reliable, and automated approach for breast aesthetic evaluation based on 2D frontal photographs. While limited by its inability to capture volumetric attributes or multiple viewpoints, it serves as an accessible tool for both clinical and research applications.