Purpose To investigate the relationship between the width and length of the pectoral muscle in the mediolateral oblique mammogram of the breast.Method Mammograms reviewed for this study were performed on women undergoing routine mammographic screening with BreastScreen NSW South West, Australia. The study included a total of 2800 randomly selected mediolateral oblique mammograms from examinations taken between July 2004 and September 2006. Measurements of the width and length of the pectoral muscle were recorded.Results No statistically significant difference was demonstrated between the mean values for right and left width (p = 0.5293) or length (p = 0.2079). Matched pair analysis demonstrated a statistically significant difference width, (p = 0.0069) and length, (p = 0.0369). No relationship could be demonstrated between the width and length of the pectoral muscle, (p = 0.0701).Conclusion The inability to determine a relationship between the width and length of the pectoral muscle suggests that these criteria should be assessed independently of each other. This new understanding of the presentation of the pectoral muscle will enable clinically relevant redevelopment of current image evaluation systems to include statistically supported mean performance values. Further research is needed to explore the relationship of width and length to other key image evaluation criteria used in mammography image quality evaluation.