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A Prospective Evaluation of Three-Dimensional Image Simulation

Patient-Reported Outcomes and Mammometrics in Primary Breast Augmentation

Overschmidt, Bo, B.Sc.; Qureshi, Ali A., M.D.; Parikh, Rajiv P., M.D., M.P.H.S.; Yan, Yan, M.D., M.A., M.H.S., Ph.D.; Tenenbaum, Marissa M., M.D.; Myckatyn, Terence M., M.D.

Plastic and Reconstructive Surgery: August 2018 - Volume 142 - Issue 2 - p 133e–144e
doi: 10.1097/PRS.0000000000004601
Cosmetic: Original Articles
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Background: Outcomes in primary breast augmentation depend on careful preoperative planning and clear communication between patient and surgeon. Three-dimensional imaging with computer simulation is an evolving technology with the potential to enhance the preoperative consultation for patients considering primary breast augmentation. The purpose of this study was to prospectively evaluate the impact of three-dimensional imaging with computer simulation on patient-reported and objective, mammometric outcomes in women undergoing primary breast augmentation.

Methods: One hundred patients were enrolled in a prospective trial with randomized and nonrandomized arms. The randomized arm was composed of a control group consisting of patients who underwent tissue-based planning without simulation (n = 13) and an intervention group consisting of patients who were simulated (n = 10). The remainder constituted the nonrandomized group who specifically sought preoperative simulation. Patient-reported outcomes (BREAST-Q) and mammometric data were recorded and compared preoperatively and 6 months postoperatively.

Results: Over time, significantly more patients refused randomization and chose simulation (p = 0.03). Breast augmentation led to substantial improvements in satisfaction with breasts, sexual well-being, and outcome. Simulation, however, did not significantly impact patient-reported outcomes or mammometric parameters. No strong correlations were identified between patient-reported outcomes and mammometrics.

Conclusions: Patients are likely to use novel technology such as three-dimensional photography with computer simulation if they perceive it to enhance their understanding of their final outcome. These patients may seek out practices specifically offering such technology. Incorporation of simulation into the preoperative consultation, however, did not lead to clinically meaningful changes in patient-reported outcomes.


This and Related “classic” Articles Appear on for Journal Club Discussions.Evidence-Based Outcomes Article.

St. Louis, Mo.

From the Divisions of Plastic and Reconstructive Surgery and Public Health Sciences, Department of Surgery, Washington University School of Medicine.

Received for publication September 2, 2017; accepted January 26, 2018.

This trial is registered under the name “3D Breast Imaging for Cosmetic and Reconstructive Breast Surgery,” identification number NCT01964105 (

The authors listed first and second are co–first authors and contributed equally to this article.

Disclosure: Dr. Myckatyn receives grant funding, consultant, and advisory board fees from Allergan, investigator-initiated grant funding and consultant fees from LifeCell, investigator-initiated grant funding and consultant fees from RTI, and advisory board fees from Viveve. Dr. Tenenbaum receives grant funding and consultant fees from Allergan, grant funding from Mentor, and advisory board fees from Viveve. No other authors report any disclosures.

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch.

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Terence M. Myckatyn, M.D., Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, St. Louis, Mo. 63110-1010,

©2018American Society of Plastic Surgeons