The Inframammary Fold Effacement Flap for Strong Fold Breast Augmentation Patients

A short distance from the inframammary fold (IMF) to the nipple is frequently encountered in patients presenting for breast augmentation and requires recognition and specific operative steps to achieve an aesthetically acceptable result. In these patients, the IMF may fail to efface with arm elevation, often termed a strong fold. Lowering the fold during implant insertion necessitates obliteration of the native IMF; failure to do so can lead to mild bottoming out or double-bubble deformity, a lower pole complication best mitigated at the initial operation. This article presents a novel technique for effacing the native IMF in patients with a strong fold and short nipple-to-IMF distance. The IMF effacement flap is a superiorly based adipofascial flap that allows obliteration of the native IMF while providing additional lower pole support for the implant and defining the new IMF. Dissection of a 1- to 2-cm-thick flap of superficial fascia and underlying tissue from the overlying subcutaneous adipose tissue proceeds from the incision 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 maneuver of intradermal fat grafting to further obliterate the native IMF and prevent double-bubble deformity.