A Novel Classification of the Inframammary Fold for Use in Primary Breast Augmentation

Phillips, Nicole A.; Millan, Lincoln Saito; Miroshnik, Michael; Stradwick, Luke; Layt, Craig

doi:10.1097/prs.0000000000008563

Cited by 8 publications

(3 citation statements)

References 19 publications

(19 reference statements)

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“…The position of the IMF needs to be adjusted accordingly due to the implantation of breast prosthesis or preoperative asymmetry of the IMFs. As a result of the failure of the IMF management, several postoperative complications would appear, such as double-bubble, implant descent, and visible scar ( 15 , 16 ). Additionally, breast reduction removes the inferior glandular and skin tissue of macromastia, thus requiring IMF elevation and reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Quantitative assessment of inframammary fold in Asians: an MRI study

Wang,

Yi,

Ren

et al. 2023

Gland Surg

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Background The inframammary fold (IMF) is a critical structure affecting the aesthetics of the breast, yet the anatomy and location of the IMF remain controversial. The purpose of this study was to quantitatively evaluate the thickness and location of IMF utilizing magnetic resonance imaging (MRI). Methods The MRI images of 240 breasts from 120 Asian women were analyzed. The quantitative measurements consisted of breast width, breast projection, nipple to inframammary fold, breast volume, IMF tissue thickness, and IMF position. The IMF position was evaluated by referring to the ribs, as well as measuring the distance between IMF and the inferior of the fifth rib. Results The mean values of central thickness, medial thickness, and lateral thickness were 1.50±0.59, 1.46±0.60, and 1.76±1.04 cm, respectively. IMF central thickness demonstrated a moderate positive correlation with breast projection (r=0.559, P<0.001) and breast volume (r=0.523, P<0.001). The proportions of IMF located at the fourth intercostal, the fifth rib, the fifth intercostal, the sixth rib and the sixth intercostal were 5.8%, 29.2%, 43.3%, 20.4% and 1.3%, respectively. The average distance between IMF and the inferior of the fifth rib was 0.69±1.40 cm. 60.0% of women had near-symmetrical IMF, while 17.5% had left higher IMF and 22.5% had right higher IMF. Conclusions This study used MRI to quantitatively assess the anatomy of IMF. The detailed knowledge of IMF would facilitate the ideal aesthetic outcome of mammaplasty.

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Section: Discussionmentioning

confidence: 99%

Quantitative assessment of inframammary fold in Asians: an MRI study

Wang,

Yi,

Ren

et al. 2023

Gland Surg

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“…Breast augmentation has become one common operation in plastic surgery for cosmetic factor [1][2][3][4][5]. However, many patients suffer from moderate-to-severe pain after the surgery due to the insertion of subpectoral prostheses into the breast tissue and surgical dissection of the tissues [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

The analgesic efficacy of pectoral nerve block for breast augmentation: a meta-analysis of randomized controlled studies

Yang,

Wang,

Wang

2023

JPHS

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Background: Many patients suffered from serious pain after breast augmentation, but the analgesic efficacy of pectoral nerve block for these patients was not well established. Thus, this meta-analysis was intended to study the analgesic efficacy of pectoral nerve block for breast augmentation. Methods: Several databases including PubMed, EMbase, Web of Science, EBSCO, and Cochrane library databases were searched, and we included randomized controlled trials (RCTs) regarding the analgesic efficacy of pectoral nerve block for breast augmentation. Results: Six RCTs were ultimately included in this meta-analysis. Compared with control intervention for breast augmentation, pectoral nerve block could significantly reduce pain scores at 1 h (mean difference [MD] = −2.28; 95% confidence interval [CI] = −3.71 to −0.85; P = 0.002), 2 h (MD = −3.08; 95% CI = −3.95 to −2.20; P < 0.00001), 4 h (MD = −2.95; 95% CI = −3.32 to −2.58; P < 0.00001), 6–8 h (MD = −2.68; 95% CI = −3.24 to −2.11; P < 0.00001), 24 h (MD = −2.04; 95% CI = −2.41 to −1.67; P < 0.00001), the number of analgesic requirement (odd ratio [OR] = 0.20; 95% CI = 0.09 to 0.45; P = 0.0001), and the incidence of nausea (OR = 0.21; 95% CI = 0.08 to 0.54; P = 0.001) and vomiting (OR = 0.15; 95% CI = 0.05 to 0.39; P = 0.0001). Conclusions: Pectoral nerve block may be effective for pain relief after breast augmentation.

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“…We congratulate Phillips et al on a fine study regarding the inframammary fold in women presenting for breast augmentation. 1 The authors also note the lack of conformity regarding inframammary fold histology among investigators. We also wish to highlight some issues.…”

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confidence: 99%

Letter to the Editor: A novel classification of the inframammary fold for use in primary breast augmentation.

Hudson

Lelala

2022

Plastic &Amp; Reconstructive Surgery

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fold histology among investigators. We also wish to highlight some issues.Caveat 1: The inframammary fold is a variable structure that may be poorly formed in severe hypoplasia (type F0 and F1 breasts, 26 percent in their study). When the inframammary fold is better developed, it is essentially a subcutaneous structure occurring between the superficial fascia and the skin, but it also has a deeper component, emanating from deeper structures (i.e., deep fascia or periosteum), that is more tenuous. Raising the arm stretches the poorly formed subcutaneous structure and effaces it in F0 and F1 breasts. In contrast, in patients presenting with macromastia, 2 the fold was always present (F3).Caveat 2: The inframammary fold is mainly a subcutaneous structure, similar to the nasolabial fold or buttock crease. If a new fold is created, the whole length of the original inframammary fold must be destroyed from medial to lateral or it will persist, especially in the F3 breast. If a new fold is formed, it should ideally be recreated from the medial aspect of the breast to its lateral aspect, not just along the suture line.Caveat 3: A double-bubble deformity 3 occurs when a prosthesis is placed below the original inframammary fold, unless the original fold is totally destroyed, which becomes more difficult as the inframammary fold definition increases. The deformity occurs irrespective of the plane in which the prosthesis is inserted. It will be more obvious clinically in F3 breasts if the neo-inframammary fold is designed lower than the original fold, as shown in their study. It is the subcutaneous part of the inframammary fold that persists. If the prosthesis is bigger than the vertical breast foot plate, this will create a double bubble, except when there is a poorly defined fold (type F0 and F1).Caveat 4: There is a ratio of suprasternal notch to nipple::nipple-inframammary fold of usually 21:7 in the "ideal" breast. 4 Nipple position is slightly changed by augmentation; it is usually elevated by approximately 1 cm. In contrast, the nipple-to-inframammary fold distance lengthens with augmentation, even if the original inframammary fold is retained. Hence, by insertion of a "large" prosthesis combined with lowering the inframammary fold (2 cm or more), that "golden ratio" is distorted, which may lead to the "headlight" breast, where the nipple sits in the middle of the breast and the suprasternal notch-to-nipple distance is similar to the nipple-to-inframammary fold.Caveat 5: The inframammary fold will descend with time due to the weight of the prosthesis 5 and aging. Fixation of the incision/fold is critical to minimize this outcome. The inframammary incision is usually about 5 cm long, but the inframammary fold runs from the medial aspect of the breast to the anterior axillary line. These inframammary fold sutures, acting together with the integrity and strength of the rest of the inframammary fold, provides support to the prosthesis. The inframammary fold is more tenuous between the deep fascia/muscle and the superfici...

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A Novel Classification of the Inframammary Fold for Use in Primary Breast Augmentation

Cited by 8 publications

References 19 publications

Quantitative assessment of inframammary fold in Asians: an MRI study

Quantitative assessment of inframammary fold in Asians: an MRI study

The analgesic efficacy of pectoral nerve block for breast augmentation: a meta-analysis of randomized controlled studies

Letter to the Editor: A novel classification of the inframammary fold for use in primary breast augmentation.

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