Intraoperative Sizing

[Rach13]

Dr. Sorokin,

What's your opinion re: use of intraoperative sizing? Do you use it in your practice? Are their any pros and cons to its use? I had read somewhere that it increases the risk for complications and that "experienced" surgeons don't "need" to use it. Then on the other hand, I've heard some say that it enables the surgeon to see exactly how many ccs get the desired look, balance asymmetry, etc. Just wondering what your opinion is... Thanks in advance!

[Rach13]

As a follow-up to these questions, I would also like to know the difference between (if there is one) using "intraoperative sizing" and the surgeon just bringing in different size implants into the OR that day. How does this latter process work exactly? Does the PS still sit the patient up and examine the size? If it's not the right size, what happens if not using sizers? Is the implant remove and a new one reinserted? Also, what's the best process for correcting assymetry, esp with using silicone? Thanks in advance for any help with these issues!

[DrSorokin]

My own belief is that intraoperative sizing is not usually necessary. It adds a step to the procedure where a foreign object is placed in the pocket and can potentially increase infection risks. While most surgeons do indeed use disposable sizers these days there are some surgeons that resterilize sizers and to me this is a very bad technique. Furthermore the shape of some of the sizers does not always match the shape (projection) of the implants being used so it can give a false appearance. Sizing should be determined by the breast measurements preoperatively and the patient's desires. The surgeon should have a pretty good idea as to what size implant is going in preop. Occasionally if the patient is very asymmetric and one side will need a different size implant it can be useful in these cases. As far as the need to bring extra sizes to the OR, I myself keep about 20 different sizes on hand at the OR at all times so I always have what I potentially need. If I put in an implant that I simply think is too big or too small after sitting her up and looking, I will take out that implant, and use a new one. At this point I have made an expensive mistake as throwing out that implant comes out of my pocket. I have done this on extremely rare occasion as I would rather have a happy patient. It should not happen often. Sitting up isn't really to check size as much as symmetry and shape and position as size should be pretty well determined before I even get to the OR. I hope this helps.