A fabrication system and method for prosthetic appliances employs imaging of a contralateral skeletal structure for designing a matched, patient specific replacement appliance based on the patient's own skeletal structure. Many skeletal structures are disposed on opposed sides, i.e. left and right sides. A contralateral bone or skeletal member often accurately depicts the individual bone shape of a particular patient more accurately than a generalized approximation. A scan such as a CT or MRI is segmented to apportion a skeletal member for replacement and reconstructed into a 3D (3 dimensional) model. The 3D model is inverted to define the contralateral side, and augmented for surgical connection features and comparison with an anatomic ideal to mitigate imperfections. 3D printing and/or additive manufacturing techniques are invoked with biocompatible materials to render the replacement prosthetic appliance based on the model.