Decades ago, plastic surgeons helped patients understand the size of their future enhanced breasts by placing bags of rice in their bras. We've come a long way since then. But plastic surgeon Kevin Small, M.D., says more progress is still needed to help women accurately understand how breast implants will affect their busts.
"They aren’t coming back disappointed. They’re just not getting the correct picture," says Dr. Small, assistant professor of Plastic Surgery at Weill Cornell Medicine.
So what's the solution? Three-dimensional imaging, says Dr. Small. He estimates that it's now used by only 5% or fewer of plastic surgeons who perform breast implant procedures.
"It's a better estimation tool to show the patient," he says. "It's becoming more common as an educational tool that allows patients to see what their bodies will look like in a three-dimensional picture."
Dr. Small told an audience at Plastic Surgery The Meeting 2016 in Los Angeles about the weaknesses of pre-operative "bra sizing" and the potential for 3-D imaging.
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Implant Sizer Shortcomings
"When you're putting an implant in a bra, you’re overestimating the total volume because the bra has volume itself," he tells Cosmetic Surgery Times. "The bra artificially displaces the implant medially and superiorly. That’s what a bra does: It's supposed to move breasts to create more cleavage."
Current pre-operative bra-sizing techniques also distort volumetric distribution, Dr. Small believes.
So should breast-implant "sizers" no longer be used to assist women in understanding how implants will affect them? According to Dr. Small, studies suggest that many women are satisfied with their breast implants. Still, the inaccuracy is a problem. "It's not only that they’re not selecting the right volumes," he says. "They also can’t visualize it."
He suggests that plastic surgeons need to be upfront with patients about the limits of traditional pre-operative bra sizing. "The most important thing is to tell patients that it overestimates the bra volume and also distorts the shape."
He also recommends 3-D imaging because he believes it offers accurate and reproducible perspectives on how implants will affect patients. Through 3-D imaging, he says, patients "can see what their breast will look like with the implants in. It temporarily puts the implants underneath the breast envelope and simulates what the breasts will look like."
However, Dr. Small cautions that even with 3-D imaging it's just a prediction. “Patients have to know that beforehand. It doesn’t account for how the tissue envelope changes over time. As people get older, their breast shape changes and starts to sag."
Still, he says, "It's another tool."
And in the future, he says, 3-D printing technology may allow the creation of torso models that plastic surgeons can use in the operating room "to remind them of what the patient wants to look like." This is especially important, he says, "since patients look different when they’re lying down versus sitting up and standing."
In addition, he says, patients could take the miniature torsos home so they can assess them with their families prior to surgery.
Dr. Small has no relevant disclosures.