Implant Bra Sizing: Are Patients Getting Accurate Information?

Background: Pre-operative bra sizing with implants is a common method/tool, for both the patient and surgeon, to preoperatively select implants for breast augmentation; however, no series has corroborated the accuracy of bra sizing with post-operative outcomes.  Alternatively, previous investigations from our group and others have validated the utility of three-dimensional imaging and analysis, specifically comparing the efficacy of preoperative simulations to post-operative outcomes. This investigation utilizes three-dimensional imaging to determine if preoperative bra sizing provides equivocal information compared to surgical simulation for patient education prior to a breast augmentation.

Methods: During an initial primary breast augmentation consultation, patients received preoperative three-dimensional images and associated surgical simulations.  Sizers, equivocal to the implants chosen in the simulation by the surgeon and patient, were placed in a surgical bra, and three-dimensional images were repeated. Volumetric and contour analyses were compared between the surgical simulation and the bra/sizer image.  Of note, all patients used a First Impressions Post Surgical Mastectomy Bra (size small, 32-34) and smooth, round silicone sizers, average volume 302 cc (Range 265-339 cc).

Results: 7 patients (14 breasts) underwent 3D imaging with the Canfield Vectra System. The average volume of the bra/sizer image was 22.3% greater than the preoperative simulated breast image. The mean absolute difference (root mean square) of all surface points between the two breast images in aggregate was 9.25 mm (range, 5.98-11.96 mm; standard deviation, 8.59). The maximum anterior displacement of the bra image from the simulated image was 19.52mm, centered at the upper pole; the maximum posterior displacement of the bra image from the simulated image was 25.49mm, centered at the lower pole.

Conclusions: Previous investigations have documented preoperative surgical simulations with three-dimensional imaging to be reliable and accurate.  In comparison to software simulation, this study suggests bra sizing not only overestimates the post-operative volume but also distorts the volumetric distribution and the anterior-posterior projection.  Further investigations in a larger series are indicated; however, this investigation outlines some deficiencies of bra sizing for patient education and informed consent in a breast augmentation.