Do your breasts actually come out looking like the 3D virtual image?

No, the photo you see is not exactly what you will achieve with surgery. Sometimes it is fairly close, and sometimes it is not. You can also try on sizes to give you an ides of the weight and volume in your clothes.

For my patients for breast augmentation, we have been using the 3D virtual imaging system for 6 years. This image renders a 3D view that can allow patients to see what they might look like after breast augmentation surgery. The patient can try on different sizes. We have found that while it is not perfect it is pretty close but this also depends mostly on the preop image. If there are shadows under the breast or saggy breast skin then the 3D device doesn't always know what to do with that. So the initial image can look distorted before you even "try" on implants. So we educate patients but the majority of patients can visualize things well. We have even recently started to do this with breast reduction surgeries.

Dear LeighH,
3D virtual imaging can be a good tool, but generally speaking, it doesn't give great results. Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 
When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery