Inframammary Fold Reconstruction Techniques: A Scoping Review

The inframammary fold (IMF) is a crucial anatomical structure that influences breast aesthetics after reconstruction. However, mastectomy often compromises the IMF, necessitating effective reconstruction techniques. Current approaches vary, and no consensus exists regarding the optimal method.

A scoping review was conducted using PubMed and Embase. Twenty-five eligible studies describing IMF reconstruction were included. Surgical techniques were categorized into open (direct and indirect access), closed, and other approaches. Data were analyzed for techniques, outcomes, and complications.

Open approaches offered superior visualization and precise IMF anchoring but required larger incisions and carried higher complication risks. Direct access typically used de-epithelialized dermal flaps following the IMF incision, whereas indirect access relied on existing scars to anchor the capsular, superficial fascia, dermis, or combinations thereof. Closed techniques reduced invasiveness but limited visualization, complicating fixation. One study evaluated liposuction to enhance skin-fascia adherence, demonstrating its potential benefit. Suture methods varied widely, with some studies describing barbed sutures; however, skin-fascia adherence seemed more important than suture choice for durable IMF reconstruction. Recurrence of IMF displacement was common across all techniques.

No single IMF reconstruction technique has been established as superior. The predominance of implant-based reports and the absence of comparative or prospective studies limit definitive conclusions. Future prospective research should compare long-term outcomes across technique categories and investigate adjunctive strategies, such as liposuction, for enhancing IMF stability.