Gender is defined by a cultural perception, so all attractiveness would be encompassed within the cultural perception. So a lady who gets her breasts augmented wouldn't essentially matter whether it is to self affirm or vanity or to attract others, it would all just fall into what culture taught that person was appealing.

I'm sure there are many that would pick my wording apart or disagree, but maybe that answers some of your question? Self affirmation and vanity I would say are not mutually exclusive though, there is overlap.