Things to consider when conducting inframammary fold incision

In the first surgery, I tend to select axillary / inframammary / areola incision in ratio of 4:4:2. I tend to hear some weird informations when I talk to the patients. Some tell me that “inframammary fold incision is only for the beginning surgeons because it is a basic skill.”



I thought that this was some nonsense when hearing it from a perspective of a well experienced surgeon. This is why today, I would like to share about the things to consider when conducting inframammary incision.

Inframammary fold incision is not something good for beginners to perform.

All surgeries have some things that are easy and not, but we cannot say that appendectomy and cesarean or any other operations are easy. Nothing are as simple as you say.

The problem with the inframammary fold incision is the location of the incision.



Desquamation and putting in the implant are enough for areola or umbilical incisions. But for inframammary fold incision, first we need to estimate where the inframammary fold is and then conduct the incision.

So if the incision itself is done is the wrong place, there is no turning back. When we design the surgery, we need to exactly estimate the correct incision spot. This requires much experience.

This is not something that can be done lightly. There are many different variables for different patients such as the area of the implant and the other is how elastic the skin is.



The area of the implant can be found in the information provided by the manufacturers and we refer to that when drawing out the location where the implant would be put in. The problem here is that when the implant goes in into the breast, the skin gets pulled and becomes tight causing the areola/nipple to shift from the original location. So we need to foresee this change and know where the areola/nipple to shift to in order to draw out the implant housing position.

There is another variable. It is the distance between the nipple and the inframammary fold. The skin in this area extends in different degree from one person to another. So when we design the procedure, the assistant has to pull the breast skin towards the collar bone and measure the distance from the nipple to see where the new position of the inframammary fold would be.

In most of the time, the doctor uses formula of implant height and others in order to find out the distance between the areola and the new inframammary fold. The number would increase for aged patients who have loose skin and decrease for those young patients who have tight skin.

It also becomes difficult if the location of areola and the breast mound are different. If the right breast is rather higher than the left, then the implant pocket of the left breast would have to be made below the pectoralis muscle and there should be dual plane on the right breasts so that the right breast is pulled up more with the usage of the implant. We consider this point and design the procedure so that the left and right breasts are at the same height level after the breast augmentation.



It becomes a little easier if the left breast if lower than the right but it is larger than the right breast. If we put in larger sized implant on the left breast than the implant would pull down making the inframammary fold of both breasts at the same level.

Suture is also important in inframammary fold incision. It is different to that of axillary and umbilical incision. The incision is done on the bottom part of the breast and this has to hold the implant. If there is some inflammation caused or the stitch loosens then the whole surgery must be conducted again.

Not only is stitching necessary, but we need to maintain the capsule and others as much as possible along with precise desquamation. We need to suture all the structures in the body in perfect shape. The surgeon needs to be careful of all these factors in order to avoid any complications that might be caused.

Inframammary fold incision can be applied to any shape of breasts and any situations with many different techniques to come up with best possible result. But, one must be more careful about the things that you do not need to be careful of in other incision methods in order to avoid any complications and problems.

This is why inexperienced doctor cannot perform with good result.

I hope the contents have helped you today.
Thank you for reading and have a great day.