Seeing is believing: Why I wish I'd had 3D imaging before my breast augmentation
When I got my breast augmentation in 2022, I spent many weeks after surgery catching reflections of my new silhouette and feeling like I was looking at somebody else. It was psychologically disorienting.
I'd catch glimpses of myself in a mirror and do a double-take. I didn't feel regret; I liked the image I saw, but it didn't feel familiar, either. It was like looking at someone else's body for a while, and it took many weeks for my mind to recalibrate my old mental image of myself with my new reality.
This is why I wish 3D imaging had been part of my consultation process. I remember looking down at my chest in compression gear as I lay in recovery from surgery and having no clue what my breasts looked like under the supportive Lycra. If a 3D image had been rendered at my consultation, I would have carried it around on my phone and looked at it during the months I waited for surgery. I could have started getting used to the projected contours of my new breasts and wouldn't have felt the uneasy sense of mystery I did those first few hours after surgery.
When I heard recently that many surgeons offer 3D imaging technology to their patients, I felt that seeing a visual beforehand would have helped me feel more prepared for my breast augmentation.
3D imaging creates a simulation of what a patient's breasts may look like after surgery. Patients can keep these pictures with them to get used to the upcoming change. Having an image like this could have helped me visualize and mentally prepare for my new curves.
Tiffany McCormack, MD, brought a VECTRA 3D Imaging system into her practice more than a decade ago and hasn't looked back. She said her patients like it, and it saves her time in the operating room.
VECTRA creates a 3D simulation of your body to help you preview how cosmetic procedures, such as breast augmentation, might look.
"It's a really nice tool and I don't do a breast consultation without it," said Dr. McCormack.
Choosing an implant size
The volume of a breast implant is measured in cubic centimeters (cc). On average, choosing a 200 cc implant can result in approximately one cup size increase, although this can vary depending on your frame and existing tissue. As a general rule, a 400 cc implant will result in an increase of two cup sizes; however, this can vary depending on your chest size, implant profile and individual anatomy.
I didn't know this when I got my breast augmentation. I remember my surgeon mentioning a 400 cc implant during my virtual consultation, but I had no idea what this meant, much less how this would affect my silhouette. I nodded along and smiled, but didn't think to ask how it could adjust my bra size. For me, "400 cc" was clinical, not visual.
It would have been helpful to have been shown a 3D image of my anticipated results so that the shock wouldn't have been as strong afterwards. It took a good month or so before I stopped feeling surprised every time I caught a glimpse of my reflection. Slowly, I began to feel more like myself, just a more curvaceous version.
Choosing an implant size on the operating table
Some ASPS Member Surgeons use temporary intraoperative sizers during surgery to finalize implant selection. They place it in the breast pocket long enough to raise the patient to a seated position and visually assess its appearance. This standard technique allows them to tailor the result in real-time based on the patient's anatomy.
Using the VECTRA imager beforehand limits the need for Dr. McCormack to use sizers in the operating room. She prefers to determine implant size ahead of time, which enables her to finish surgery more efficiently and get her patients into the recovery room. This approach reduces her time in the OR and the time a patient is under anesthesia, which can be considered a win-win.
Using sizers in front of a mirror
Many surgeons sample implant sizes with their patients through a low-tech system where the patient stands in front of a mirror during a consultation and inserts different sizers, or temporary implant-like bags filled with silicone or saline, into their bra.
Yet, because many consultations are now virtual, as mine was, some patients miss out on this visual preview of what their results could look like.
McCormack begins her in-person consultations by having the patient insert these sizers into their bra, but after that, the consultation turns high-tech.
Bringing in 3D imaging
"Once I have a range of what they're liking in the mirror, then I'll go to the 3D imager and narrow that down to the exact size," said Dr. McCormack.
She uses a handheld VECTRA 3D imaging model to capture front and side view images of her patients, which she then uploads to the software.
The patient's images appear on a screen, where the surgeon selects a specific implant size, profile and projection, and the computer software simulates what the patient could look like after surgery.
Patients can virtually "try on" different types and brands of implants and even add virtual clothing to see, for example, how they'd fill out a bikini or tank top after surgery.
"I think patients really need to see different sizes, projections, profiles – different types of implants on their body," said Dr. McCormack.
3D imaging helps visualize improvements
McCormack can use 3D imaging to correct breast size discrepancies. If one breast is larger than the other, which is the case for many women, VECTRA 3D can virtually try on a different implant size for each breast to show how she can potentially correct the asymmetry.
"It's also really helpful in showing a patient who isn't sure if they need a lift what it might look like to just put an implant in without a lift or what it might look like to just do a lift without an implant," said Dr. McCormack.
She can show the patient their current nipple placement compared to what they would look like if she surgically adjusted their nipples.
Not a crystal ball: Results may vary
Dr. McCormack considers computer-generated imaging a technology that helps her talk about what her patients' breasts "could" look like after surgery, but she warns that it can't predict or guarantee actual surgical outcomes. Results depend on a patient's unique anatomy, how they heal and surgical variables.
"This is just a computer image," said Dr. McCormack. "Don't take this too seriously – it's a helpful adjunct."
Living up to expectations
I wondered if some surgeons might not want to use 3D imaging because patients might take the image literally and expect their results to look just like the picture. Ryan Diederich, MD, who also uses VECTRA 3D imaging, said this has not been his experience.
"The fear with it was that you'd give an unrealistic look of what they're going to get," said Dr. Diederich. "What I found was that it actually seems to do the opposite. It gives them a little bit more realistic look of what they're going to get because they identify the things they don't like."
When patients can examine a 3D image and say, "I don't like something," Diederich said the surgeon and the patient are better able to work together toward a result the patient wants.
Enhancing remote consultations
For Ellen Janetzke, MD, 3D imaging was helpful during the COVID-19 pandemic for virtual consultations, as it enabled patients to preview potential results from the comfort and safety of their own homes.
Patients sent in front and side view photos before the consultation, and Dr. Janetzke then uploaded the images into a 3D imaging platform called Crisalix. The software created a virtual preview of how different implant sizes, profiles and placements might look on their body after breast augmentation.
She said remote 3D consultations are still popular in her practice, especially for patients who travel for surgery.
Cost effectiveness
3D imaging systems are an additional expense for surgeons, but Dr. Janetzke said the cost has been worthwhile for her practice.
"When we started to use Crisalix, because the patients were able to see and therefore help decide their potential size, almost every one of those potential patients ended up having surgery with us," said Dr. Janetzke. "Before using it, our conversion percentage was not as high."
For the surgeons I spoke with, 3D imaging isn't just helpful for patients – it also makes their job easier. It makes consultations more visual, improves communication, sets realistic expectations, reduces OR time and can even increase the number of consultations that become booked procedures. I wish more surgeons offered it.
I'm absolutely thrilled with my breast augmentation results, and they've made me feel more confident, but looking back, I do wish I'd had a better visual beforehand. If 3D imaging had been part of my consultation, it would have helped me feel more mentally prepared for the change. Seeing a realistic preview could have made the whole experience a lot more empowering and better prepared me for my new curves.
For anyone thinking about getting a breast augmentation, ask if your board-certified plastic surgeon offers 3D imaging. If not, ask the assistant to take pictures for you (with your own camera) while you try on sizers, so you can refer to them later.
Maybe your consultation is virtual, 3D imaging is not an option, and you're traveling for your augmentation, as was my case. If so, request an extra half hour to be added to your prep time before surgery, allowing you to try on sizers to get a visual of what your results might be.
After all, a glimpse into your future self before breast augmentation can help make you feel more prepared for your new look afterwards.
To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.
