Bra sizing and the plastic surgery herd effect: Are Breast augmentation patients getting accurate information?

Background: Bra sizing is a common method to preoperatively select implants for breast augmentation; however, no series has analyzed the accuracy of this modality postoperatively. Alternatively, previous investigations have validated the accuracy and utility of three-dimensional (3D) imaging for preoperative simulation in breast augmentation. Objectives: This investigation utilizes 3D analysis to determine if preoperative bra sizing provides equivocal information compared to surgical 3D simulation for patient education and planning prior to a breast augmentation. Methods: During primary breast augmentation consultation, patients received preoperative 3D images and associated simulations. Sizers, equivocal to the implants chosen in the simulation, were placed in a surgical bra, and 3D images were repeated. Volumetric and contour analyses were compared between the surgical simulation and the bra/sizer image. All patients used a surgical bra and smooth, round silicone sizers (average volume, 302 cc; range, 265-339 cc). Results: Seven patients (14 breasts) underwent analysis and comparison. The mean bra/sizer volume image was 22.3% greater than the preoperative simulated breast image. The mean absolute difference of all surface points between the two breast images 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 19.52 mm, centered at the upper pole; the maximum posterior displacement was 25.49 mm, centered at the lower pole. Conclusions: In comparison to 3D simulation, preoperative bra sizing overestimates postoperative volume, and upper pole fullness and underestimates lower pole projection. This investigation outlines some deficiencies of bra sizing and offers solutions for clinical management in primary breast augmentation.