Three-dimensional assessment of macromastia: linking breast morphology to quality of life

Macromastia is associated with substantial physical and psychosocial burden, yet existing diagnostic thresholds, particularly for gigantomastia, are largely derived from weight-based criteria established in Western populations. These standards may be suboptimal for preoperative assessment in Asian women, where breast composition and body habitus differ.

In this cross-sectional study, adult women with breast volumes > 400 mL were recruited from a tertiary plastic surgery center. Preoperative breast morphology was assessed using the VECTRA® XT 3D imaging system, including breast volume, breast width, SNN distance, and ptosis grade. QoL was evaluated using the BREAST-Q Reduction/Mastopexy Module (version 2.0). Associations among morphological parameters, BMI and BREAST-Q domains were comprehensively analyzed.

A total of 145 patients underwent 3D imaging and 168 completed the BREAST-Q questionnaire. Fifty-three patients completed both assessments and were included in analyses integrating breast morphology and patient-reported outcomes. Breast volume was positively correlated with BMI and ptosis severity (P < 0.05). SNN distance demonstrated a stronger correlation with ptosis grade (ρ = 0.657, p < 0.001). Patients with breast volumes ≥ 1,000 mL demonstrated significantly greater ptosis severity and lower physical well-being scores compared with those with moderate macromastia. BMI showed stronger unadjusted associations with psychosocial well-being, sexual well-being, and satisfaction with breasts than breast volume alone. However, these associations were attenuated after multivariable adjustment.

Three-dimensional imaging combined with BREAST-Q assessment provides complementary information on the anatomical and patient-reported burden of macromastia. Breast volumes of 1,000 mL or greater were associated with increased ptosis severity and poorer physical well-being and may represent a clinically relevant threshold warranting further investigation. These findings support a multidimensional approach to preoperative evaluation that incorporates breast morphology, body habitus, and patient-reported outcomes.