Current ultrasonic scatterer size estimation methods assume that acoustic propagation is free of distortion due to large-scale variations in medium attenuation and sound speed. However, it has been demonstrated that under certain conditions in medical applications, medium inhomogeneities can cause significant field aberrations that lead to B-mode image artifacts. These same aberrations may be responsible for errors in size estimates and parametric images of scatterer size. This work derives theoretical expressions for the error in backscatter coefficient and size estimates as a function of statistical parameters that quantify phase and amplitude aberration, assuming a Gaussian spatial autocorrelation function. Results exhibit agreement with simulations for the limited region of parameter space considered. For large values of aberration decorrelation lengths relative to aberration standard deviations, phase aberration errors appear to be minimal, while amplitude aberration errors remain significant. Implications of the results for accurate backscatter and size estimation are discussed. In particular, backscatter filters are suggested as a method for error correction. Limitations of the theory are also addressed. The approach, approximations, and assumptions used in the derivation are most appropriate when the aberrating structures are relatively large, and the region containing the inhomogeneities is offset from the insonifying transducer.