The Effect of Patient Involvement in Implant Size Selection on Satisfaction With Breast Size: An Analysis of 1840 Primary Augmentations

Abstract Background Aesthetic breast surgery is a specific field in which the aim is not to achieve any universally defined standard but to meet the patient's expectations. Objectives The aim of this study was to determine the proportion of women who were dissatisfied with their breast size following primary breast augmentation and opted to undergo revision surgery. The study presents and verifies an algorithm for breast implant selection which involves the patient in the decision-making process. Methods A retrospective analysis was performed of medical charts covering the period from January 2012 to December 2022 from 1 private center. The final analysis included 1840 patients. All had implants chosen according to the Patient Decision-Making Process on Implant Size Selection (PIS) algorithm. Results Of the studied cases, 18 opted to undergo implant exchange due to dissatisfaction with breast size (0.98%). This group differed significantly from the controls (n = 1822) in the following aspects: lower BMI during primary procedure, lower mean implant volume, and shorter follow-up. In all but 2 women, mean BMI increased by 1 unit before revisional surgery (from 19.7 to 20.6 kg/m2). Conclusions Dissatisfaction with breast implant size is a rare cause of revision in breast augmentation surgery when the patient is involved in the final decision on the volume of the implants. The PIS algorithm yielded a rate of dissatisfaction with breast size of less than 1% in long-term follow-up. Level of Evidence: 4 (Therapeutic)