Background: Bottoming out, or pseudoptosis, is a well-known phenomenon that is associated 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 is the first to report the application of three-dimensional (3D) photography to objectively investigate changes in breast morphology associated with bottoming out.

Methods:  From July 2006 to December 2006, 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 analyzed using a Boolean operation and a standardized chest wall.  Bottoming out was assessed with various 3D parameters and vectors including: total breast volume, volumetric tissue distribution above and below the inframammary fold (IMF) plane, distance of the IMF-plane to the lowest point of the breast, and maximum anterior-posterior projection from the chest wall.

Results:  A completed series of 3D images were obtained from 15 RM patients. The total breast volume decreased 20.6% from the early to late postoperative period. The percent of breast tissue below the inframammary fold significantly increased from the early to late postoperative scan. (24% to 31%, p<0.01)  Further evidence to suggest bottoming out included a significant increase in the distance from a fixed IMF-plane to the bottom of the breast (9mm, p<0.01) as well as a decrease in AP projection (6.23mm; p<0.01) and a drop in the position of the lateral border of the IMF (6.27mm; p<0.01).IMF-plane to the lowest point of the breast, and maximum anterior-posterior projection from the chest wall.

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 demonstrate that bottoming out occurs during the initial 18-month post-operative period and encompasses significant changes in volumetric distribution, surface topography and breast projection. This study also demonstrates, for the first time, that breast volume continues to decrease from the early to late postoperative period after RM. 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.