It is generally agreed that the Last Interglacial (LIG; ∼130–115 ka) was a time when global average temperatures and global mean sea level were higher than they are today. However, the exact timing, magnitude and spatial pattern of ice melt is much debated. One difficulty in extracting past global mean sea level from local observations is that their elevations need to be corrected for glacial isostatic adjustment (GIA), which requires knowledge of Earth’s internal viscoelastic structure. While this structure is generally assumed to be radially symmetric, evidence from seismology, geodynamics and mineral physics indicates that large lateral variations in viscosity exist within the mantle. In this study, we construct a new model of Earth’s internal structure by converting shear wave speed into viscosity using parametrizations from mineral physics experiments and geodynamic constraints on Earth’s thermal structure. We use this 3-D Earth structure, which includes both variations in lithospheric thickness and lateral variations in viscosity, to calculate the first 3-D GIA prediction for LIG sea level. We find that the difference between predictions with and without lateral Earth structure can be metres to 10s of metres in the near field of former ice sheets, and up to a few metres in their far field. We demonstrate how forebulge dynamics and continental levering are affected by laterally varying Earth structure, with a particular focus on those sites with prominent LIG sea level records. Results from four 3-D GIA calculations show that accounting for lateral structure can act to increase local sea level by up to ∼1.5 m at the Seychelles and minimally decrease it in Western Australia. We acknowledge that this result is only based on a few simulations, but if robust, this shift brings estimates of global mean sea level from these two sites into closer agreement with each other. We further demonstrate that simulations with a suitable radial viscosity profile can be used to locally approximate the 3-D GIA result, but that these radial profiles cannot be found by simply averaging viscosity below the sea level indicator site.