The Quantitative Progression of Pseudoptosis after Reduction Mammaplasty
Jacob G. Unger, BA, Oren M. Tepper, MD, Kevin H. Small, BA, Daniel L. Feldman, BA, Mihye Choi, MD, Nolan S. Karp, MD.
NYU Medical Center, New York, NY, USA.
Background: Bottoming out, or pseudoptosis, is a well-known phenomenon that has been described with all types of reduction mammaplasty (RM). Despite its clinical relevance, 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 the chronological changes in breast morphology after RM.
Methods: Patients undergoing medial pedicle RM had 3D photographs (Konica Minolta V910) taken during the early, middle and late post-operative periods (early = 60-120 days; middle = 300-450 days; late = 700-900 days). Bottoming out was assessed with various 3D parameters and vectors including: total breast volume, volumetric tissue distribution above and below an inframammary fold (IMF) plane, maximum anterior-posterior projection from the chest wall, and 3D comparison.
Results: Post-operative 3D images were obtained from 15 consecutive RM patients. The average total breast volume significantly decreased from the early to middle period of 15.7% (p<0.05), with no significant change over the subsequent middle to late period ( 3.6%; p=0.77). The percent of tissue in the upper pole of the breast decreased from the early to middle period by 7% (p<0.05), but did not change significantly between the middle to late period (0.2%; p=0.97). Redistribution of the breast between the early and middle period correlated with a decrease in AP projection of 10.6% (p<0.05) and an insignificant change in projection between the middle and late period of 3.1% (p=0.66). 3D comparative analysis noted a change in overall dimension of 5 mm (P<0.05) between the early and middle period, an no further changes between the middle and late period (0.7mm; p>0.05).
Conclusions: This study provides quantifiable data to support the occurrence of bottoming out, which to date has been limited to clinical observation and descriptive studies. We objectively demonstrate that pseudoptosis occurs and encompasses significant changes in volumetric distribution, surface topography and breast projection. Further, we show that the extent of these changes is limited to the initial 18-month post-operative period. With the advent of 3D photography, it is now possible for plastic surgeons to perform an objective evaluation of breast transformation over time, which ultimately may help to better predict surgical outcomes.