Defining Pseudoptosis (Bottoming Out) 3 Years Following Short-Scar Medial Pedicle Reduction Mammaplasty
Nolan S. Karp, MD1, Michelle Quan, BA2, Ahmed Fadl, MS3, Oren M. Tepper, MD1, Kevin Small, MD4, Naveen Kumar, MD5, Mi Hye Choi, MD1.
1New York University, New York, NY, USA, 2Stony Brook University School of Medicine, Stony Brook, NY, USA, 3Stony Brook University School of Medicine, New York, NY, USA, 4NY Presbyterian (Cornell campus), New York, NY, USA, 5St Barnabas Medical Center, Livingston, NJ, USA.
Pseudoptosis (bottoming out) is a well observed phenomenon occurring after all types of breast reduction (BR) surgery. Our team used 3-dimensional imaging to objectively demonstrate that pseudoptosis occurs and breast morphology changes following short-scar medial pedicle BR. We reported that there was significant bottoming-out during the first postoperative year, but no further quantitative changes occurred in the second postoperative year. The following study uses 3-dimensional imaging to objectively evaluate how the breast changes during the third postoperative year after short-scar, medial pedicle BR.
Patients undergoing short-scar medial pedicle BR were offered enrollment in the study. Preoperative as well as postoperative 3D photographs (Canfield VECTRA 3-pod system, Konica Minolta V910) at the early, 1-year, 2-year, and 3-year postoperative periods (early = 35-140 days, 1 year = 300-450 days; 2 years = 600-850 days; 3 years = 1000-1300 days respectively). Patients were assessed for pseudoptosis and breast morphological changes with various 3D parameters as well as surface and vector measurements including: total breast volume; volumetric tissue distribution above and below an inframammary (IMF), or c, plane; 3D comparison; and distance measurements including maximum anterior-posterior (AP) projection, surface inter-nipple distance and sternal notch-nipple distance.
Ten patients had consecutive 3D photographs taken preoperatively, the early, 1-year, 2-year, and 3-year postoperative periods. The average total breast volume significantly decreased from the early to 1-year period by 20.6% (p < 0.05), there was no significant change over the second and third postoperative years (p>0.05). The percentage of breast tissue in the upper pole of the breast decreased from the early to 1-year postoperative period by 7% (p < 0.05), but did not change significantly during the second and third postoperative years (p>0.05). This redistribution of the breast parenchyma between the early and 1-year period correlated with a decrease in breast AP projection of 10.6 mm (p<0.05). The change in AP projection was insignificant during the second and third postoperative years. Additionally, the breast surface inter-nipple distance decreased from the early to 1-year period by 10.2mm (p < 0.01) with no further change during the second or third postoperative years (p>0.05). There was no significant difference in sternal notch-nipple surface and vector distances in all 3 postoperative years. 3D comparative analysis noted a change in overall dimension of 5 mm (p<0.05) between the early and 1-year period, with no further changes during the second or third postoperative periods (p > 0.05).
This study provides quantifiable data that demonstrates pseudoptosis and tissue redistribution are limited to the initial postoperative year in patients having short-scar medial pedicle BR. There appears to be minimal kinetic change in the breasts during the second and third postoperative years. With the advent of 3D photography, plastic surgeons are now able to objectively monitor the postoperative changes in breast morphology, which ultimately may help to better predict surgical outcomes. Studies are underway to compare the changes in morphology over time with different techniques of BR.