Re-defining pseudoptosis from a 3D perspective after short scar-medial pedicle reduction mammaplasty

Background: Bottoming out is a well-known phenomenon described with reduction mammaplasty (RM). To date, the evaluation of post-operative bottoming out remains an imprecise science. The following study reports the application of three-dimensional (3D) photography to objectively investigate changes in breast morphology. Methods: Patients undergoing medial pedicle RM had 3D photographs (Konica Minolta V910) taken during the early and late post-operative period (early = 60-120 days; late = 400-500 days). 3D images were compared and bottoming out was assessed with 3D parameters and vectors including total breast volume, volumetric tissue distribution above and below the Central (C) plane, distance of the C-plane to the lowest point of the breast, and maximum anterior-posterior projection from the chest wall. Results: Post-operative images from 15 consecutive RM patients showed an average volume of 556 +/- 144cm3 (early) and 441 +/- 183cm3 (late). The percent of tissue in the upper pole of the breast changed from the early to late post-operative period (76% vs. 69%, respectively; p < 0.01). The distance from a fixed C-plane to the inferior pole significantly increased (42 +/- 15 mm early vs. 51 +/- 18 mm late; p < 0.01). AP projection decreased by an average of 6.23 mm (p < 0.01). The lateral border of the IMF significantly dropped by 6.27 mm. Conclusions: This study objectively describes both the occurrence of bottoming out and the quantitative amount in terms of changes in volumetric distribution, surface topography and breast projection. With 3D photography, plastic surgeons can perform objective evaluation of breast transformation over time, which ultimately will aid in planning to allow for better surgical outcomes.