Definition of the inframammary fold in breast
reconstruction: a simplified option
Luiz Fernando Frascino
Received: 22 November 2011 / Accepted: 4 February 2012 / Published online: 21 June 2012
Background: Redefinition of the inframammary fold in
post-mastectomy reconstruction is an essential element to
achieve construction of a natural-looking breast, either using
implants and autologous tissue. Over years many techniques
have been described scheduling external surgical approach
(through incisions being made directly on the fold) or inter-
nal surgical approach (through the scar of previous proce-
dure for breast expander positioning) and using running
sutures or suture with interrupted stitches.
Methods: A modified technique for redefinition of the infra-
mammary fold using an internal approach was performed in
130 breast reconstruction procedures. Cosmetic outcomes
and stability over time were assesed.
Results: No total collapse was observed. The outcomes were
classified as very good 65.3% patients, satisfactory 23% and
poor in 9.2%. The accumulative risk for definition loss of the
reconstructed fold was 11% in eight years.
Conclusion: The technique presented in this article is a mod-
ification of already reported techniques and is easy and fast to
perform, it adds no external scars so ensuring at the same time,
natural inframammary fold definition and good reproduction
of ptosis in medium to large breasts.
Level of Evidence: Level IV, therapeutic study.
Keywords Inframammary fold
Post-mastectomy breast reconstruction has achieved levels of
excellence and it is still evolving thanks to the new concepts of
conservative cancer surgery. Techniques such as “skin-sparing
mastectomy” associated with immediate reconstruction, sets
up the premises to achieve successful cosmetic results in a
short period of time, preventing the woman from suffering
The essential element to construct a natural-looking breast
is good definition of the inframammary fold (IMF), mainly in
medium to large breasts, associated to a certain degree of
ptosis. While this goal may be more easily achieved with
techniques prescribing the use of autologous tissues, it is more
difficult to achieve, and maintain over time, a natural and
symmetrical ptosis when making reconstruction with expand-
ers and prosthesis, even if it is performed in two steps.
Implants offer many advantages over the use of flaps, like
fast and easy execution, reproducibility, lack of donor areas,
use of tissues from the same anatomical region and faster
post-surgical recovery, explaining its widespread use. The
main difficulty is to achieve natural-looking breasts, with a
correct degree of ptosis and a well-defined IMF. This often
occurs even if the general trend is to preserve this anatom-
ical structure during the demolition phase of the procedure.
Over the years, many techniques have been described to
avoid this disadvantage, using external surgical approach
[1, 2]—such as some flaps of chest advancement or dermal
tissue of de-epithelialized skin—or internal approach ,
directly through the incision of previous mastectomy, with
running sutures or interrupted stitches fixed to the chest wall.
In this report, we present a technique of post-
mastectomy definition of the inframammary fold using
an internal approach, assessing the cosmetic outcome
and stability over time and highlighting its advantages
F. Arelli (*)
Plastic and Reconstructive Surgery Unit, Sandro Pertini Hospital,
L. F. Frascino
Department of Plastic Surgery, Hospital do Coração,
Sao José do Rio Preto, SP, Brasil
Eur J Plast Surg (2012) 35:723–729