Frequency-domain ultrasound waveform tomography is a promising method for the visualization and characterization of breast disease. It has previously been shown to accurately reconstruct the sound speed distributions of breasts of varying densities. The reconstructed images show detailed morphological and quantitative information that can help differentiate different types of breast disease including benign and malignant lesions. The attenuation properties of an ex vivo phantom have also been assessed. However, the reconstruction algorithms assumed a 2D geometry while the actual data acquisition process was not. Although clinically useful sound speed images can be reconstructed assuming this mismatched geometry, artifacts from the reconstruction process exist within the reconstructed images. This is especially true for registration across different modalities and when the 2D assumption is violated. For example, this happens when a patient’s breast is rapidly sloping. It is also true for attenuation imaging where energy lost or gained out of the plane gets transformed into artifacts within the image space. In this paper, we will briefly review ultrasound waveform tomography techniques, give motivation for pursuing the 3D method, discuss the 3D reconstruction algorithm, present the results of 3D forward modeling, show the mismatch that is induced by the violation of 3D modeling via numerical simulations, and present a 3D inversion of a numerical phantom.