atient dissatisfaction with breast size after breast implant surgery can lead to early secondary procedures in a minority of cases. Different systems of sizing a patient preoperatively have been proposed, including detailed measurements and computer-assisted assessment. Whatever system is used, a surgeon needs to obtain feedback to ascertain that the system is effective at producing a satisfactory outcome. In this study, 137 patients who underwent breast augmentation by a single surgeon were prospectively assessed for a 12-week period after surgery to determine their satisfaction with their breast size. Both expectations and desire to change implant size were assessed. Early (week 1) expectations of the patients were a good predictor of their long-term assessment 12 weeks after surgery and their desire to change their implant size. The patients with a greater body mass index (BMI) and larger implant volume were more likely to express a desire for a change in implant size early in the postoperative course. The findings showed that 19.4 % (26/134) of the patients wished to have larger implants by 12 weeks after surgery and that 3.7 % (5/134) felt smaller implants would be preferable. The information produced by this audit is important to the provision of future informed consent for this surgeon. Without similar data from their individual practices, surgeons cannot provide patients with an accurate assessment of their satisfaction after breast augmentation surgery. A similar undertaking is strongly recommended for surgeons performing breast implant surgery.

Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

Subfascial (SF) breast augmentation has been proposed as an alternative to placement of a breast prosthesis in a subpectoral (SP) or direct submammary (SM) plane, producing advantages over both techniques. This study compares complication rates in 200 SF-placed implants with 83 SM implants, undertaken over a 51-month period by a single surgeon. No statistical difference was found in the complication rate or patient satisfaction of one technique over the other. No clinical advantage can be demonstrated by placing breast prostheses behind the pectoral fascia compared to directly behind the breast.

Body mass index (BMI) is the traditional way of assessing patients for body contouring surgery and has been shown to have a predictive value for surgical complications. In recent years, there have been discussions about accuracy of BMI as an indicator of obesity, and other obesity indices have been developed. This study aimed to measure and compare different anthropometric variables and examine their association with surgical morbidity. Prospective measurements of height, weight, waist, and percentage body fat were obtained preoperatively in 60 patients undergoing body contouring surgery. Demographics, patient characteristics, operative details, and postoperative complications were recorded. Statistical analysis was performed using chi, ANOVA, or Spearman rank correlations as appropriate. We found that BMI, percentage of body fat, weight, height-to-weight ratio, and waist circumference all correlate well as indicators of obesity and showed similar trends in their association with surgical complications.

A series of reproducible measurements have been developed with reference to a single midline datum that describe the position of key landmarks on the female breast. Measurements were made on a 'normal' population of 60 subjects content with their breast shape in order to (1) produce 'normal' reference data for breast shape in a population of varying weight and height; and (2) to evaluate factors which may influence the measurements. The findings show that the vertical positions of the measurements migrate inferiorly with increasing age. With increasing weight, the landmarks (except the medial end of the inframammary crease) migrate inferolaterally. Areolar diameter decreases with increasing age and increases with increasing weight. Only one of the 12 bilateral breast measurement parameters shows a significant mean difference between the right and left breast. However, in a proportion of subjects, individual measurements show fluctuating asymmetry. Subsequently, measurements were made of the breasts of women attending with requests for either reduction (n = 25) or augmentation (n = 6) mammaplasty. Compared with the 'normal' population, the group requesting reduction mammaplasty differed significantly in the majority of measurements. The group of patients requesting breast augmentation showed fewer differences compared with the 'normal' population. The average BMI of women requesting augmentation mammaplasty was significantly less and that of women requesting reduction mammaplasty significantly greater than the normal population. In conclusion, a simple and reproducible method of morphometric measurement of the female breast is described. Application of this method suggests that patients requesting reduction or augmentation mammaplasty on the NHS represent a significant deviation from 'normal' morphometry and do not simply have a subjective distortion of their own body image.