Objective To investigate the selection strategy of the prosthesis in breast reconstruction. Methods Two hundred and seventeen patients, who underwent unilateral implant-based breast reconstruction post-mastectomy from August 2006 to August 2021, were involved in this study, and the relevant information was reviewed and analyzed. The experience for the final prosthesis selection in each step during the perioperative period was summarized, including measuring the volume of the contralateral breast with the three-dimensional surface imaging technique, recording the volume of the resected tissue during breast mastectomy, recording the volume of the water injection when both sides of breasts got approximately the same volume during the expansion period, and using the sizer to verify the shape and volume before the permanent implant insertion during the surgery.

The cosmetic outcome was evaluated from three aspects, including the inframammary fold position, the protrusion and the volume of the breast. Results One hundred and sixty-four patients underwent immediate breast reconstruction, fifty-three were

provided delayed breast reconstruction, forty-one were applied immediate prosthesis insertion and one hundred and seventy-six

were applied tissue expansion/implant two-stage breast reconstruction. The median period of tissue expansion was 7.0 (5.5, 10.4)

months. One hundred and eighty-nine used anatomic prostheses and twenty-eight utilized round prostheses. The median volume

of prostheses was 225 (200, 270) mL. The median follow-up period was 7.0 (5.0, 12.0) months. Most of the patients (163/217,

75.1%) had“good”appearance evaluation, and most of the patients had capsular contracture grade Ⅰor Ⅱ(168/217, 77.4%).

Conclusion All steps during the perioperative period could provide important reference information for the selection of the

final prosthesis. Proper selection of the prosthesis could achieve symmetry to the contralateral breast in the aspects of volume,

protrusion and inframammary fold position, which make it easy to obtain satisfying reconstruction outcome.

　Breast reconstruction, 　Prothesis, 　Tissue expansion, 　Sizer, 　Three-dimensional surface imaging