The secret to making a breast augmentation patient happy with the surgical result is to make her feel like she looks great.  This usually involves meeting the patient's expectations by making her look the way she wants to look.

Many plastic surgeons have adopted a very mechanical approach to breast implant selection.  This process involves making a few measurements of the patient, and then telling her which size best fits her body.  While this process is well motivated, and may result in few surgical revisions, it may leave the patient with a result that is different from the one she really wanted.

One of the central problems with this process is that it involves trying to make measurements and decide what implant fits best.  To anyone who has tried and failed to buy clothes on the Internet, this approach seems hopeless.  Most measurements that can be made are two-dimensional, but the final fit depends on generating a three-dimensional result.

Plastic surgeons can use a process that is less mechanical and a little more like trying clothes on before you buy them. First, prospective patients should show their surgeon a picture of what looks good to them.  The Internet is full of before and after pictures that patients can look through to find examples they like.  Next, the surgeon should advise the patient about how the result in the picture would relate to her surgery.  Would it create a huge difference or a very subtle one?  Would breasts that large make someone look overweight? Would implants that small leave too much of a gap between a woman's breasts?

Once a patient and her surgeon reach agreement on size, the breast augmentation surgery can be performed.  After a space or pocket for the implant is created, the surgeon can actually "try on" various sizes to see which implant volume and dimensions are most likely to make the woman look the way she has indicated with the pictures she chose.  The surgeon can then select and place that implant.

This system works well, and though it is imperfect, it gives the patient considerably more choice in the selection of their final breast appearance.