Background <p>Breast augmentation is a widely performed aesthetic procedure, with implant selection being a critical factor influencing patient satisfaction and surgical outcomes. Traditional methods of preoperative planning, such as physical examinations and two-dimensional (2D) photography, have documented limitations in reliably predicting postoperative results. The advent of three-dimensional (3D) simulation technology offers an enhanced approach, allowing for more accurate visualization of potential outcomes.</p> Methods <p> This single-center retrospective study included a cross-sectional patient-reported survey of 106 women who underwent primary breast augmentation between August 2017 and April 2022. Patients completed a questionnaire evaluating satisfaction with outcomes, ease of volume selection, and the perceived value of 3D simulation. Patients were divided into two groups: those who received a preoperative 3D simulation (+3D group, n = 74) and those who did not (-3D group, n = 66).</p> Results <p>Median satisfaction and ease-of-volume selection scores did not differ significantly between the +3D and −3D groups. A non-significant trend toward higher volume satisfaction (scores 9 - 10) was observed in the +3D group (62% vs 43%, p = 0.079). Among patients who underwent 3D simulation, 81.8% perceived an added-value in both preoperative volume-estimation and postoperative outcome estimation.</p> Conclusions <p>While 3D simulations did not significantly alter overall satisfaction scores, they were highly appreciated by patients for their perceived accuracy and utility in implant selection. These findings suggest that 3D simulation may serve as a valuable adjunct tool to support communication and shared decision-making in aesthetic breast surgery.</p> <p>Level of Evidence: not gradable</p> Clinical trial number <p>Not applicable</p>