Preoperative Sizing for Breast Augmentation

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Drs. Hidalgo and Spector demonstrate a valuable adjunct technique for preoperative sizing in breast augmentation in the June of 2010 issue of Plastic and Reconstructive Surgery. Their approach is a patient-centric process that allows the patient to be the key decision-maker in a critical step in the implant-selection process. Unfortunately, the study design has significant flaws, including use of a nonvalidated questionnaire and use of small cohorts that yield insignificant numbers for statistical analysis. These shortcomings of this “scientific article” should not deter the reader from understanding that this important patient-centric process is extremely valuable; however, “preoperative sizing” must be coupled with objective data from measurements and assessments of the patient's chest wall; breast skin; tissue quality, quantity, and adherence; and nipple-areola position, size, and shape.
The finesse in the preoperative implant-selection process evolves as the plastic surgeon allows the patient to actively participate in the process while only offering patients implants to use for sizing that are tissue and dimensionally appropriate in width, height, projection, and volume so that the implant ultimately selected will fulfill the patient's preexisting soft-tissue and chest wall requirements. Many patients will only reveal their unrealistic expectations through this type of patient-centric preoperative sizing process. Three-dimensional imaging may also help to evaluate patient expectations; however, the software is costly.
To achieve high rates of patient satisfaction and low reoperation rates for size dissatisfaction, the plastic surgeon must actively involve the patient. This method does provide the patient with that important decision-making power, but it must be masterminded by the plastic surgeon who has measured and evaluated the objective data from the clinical examination so that the patient is guided to choose the appropriate implant that will safely fill her unique breast dimensions yet provide her with an aesthetic result with which she is satisfied. As always, as plastic surgeons, we must not only merge scientific data with the artistry of plastic surgery but also practice the art of medicine in our approach to patient care. Bravo to Drs. Hidalgo and Spector for reminding us that the patient's desires are a critical part of this implant-selection process.
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Chicago Plastic Surgeon