The Inframammary Fold Effacement flap for strong fold Breast Augmentation patients

Summary: A short inframammary fold (IMF) to nipple distance is frequently encountered in patients presenting for breast augmentation, and it requires recognition and operative steps during the procedure to achieve an aesthetic result. The IMF in these patients may also fail to efface with arm elevation, often termed a “strong” fold. Lowering of the fold for these patients during implant insertion is often embarked upon, and this necessitates obliteration of the native IMF. Failure to do so can lead to mild bottoming out, or more severe double bubble deformity, a lower pole complication that is best mitigated against at the initial operation. This article presents a novel technique for effacing the native inframammary fold in patients identified as having a strong fold with short nipple to IMF distance. The IMF effacement flap is a superiorly based adipofascial flap, allowing obliteration of the native IMF whilst providing additional lower pole support for the implant and setting the new IMF. Dissection of a 1 to 2cm thick flap of superficial fascia and underlying tissue away from overlying subcutaneous adipose tissue proceeds from the incision up to a point just cranial to the native IMF. The flap is secured with a 3 point suture, anchoring the new IMF to the chest wall and aiding in its definition. This flap is combined with the ancillary manoeuvre of intradermal fat grafting, to effectively obliterate the native IMF and avoid double bubble deformity.