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What is an Inframammary Fold or IMF?

Anatomy of The Inframammary Fold (IMF) and Its Importance in Breast Surgery Procedures

The female breast is one of the rare anatomical structures in your body that lacks any bony or cartilaginous support. It’s suspended from your chest by its soft tissues. Its final shape significantly influenced by surrounding structures such as your inframammary fold at the base of your breast.

The inframammary fold is a key visual landmark in cosmetic breast surgery, from breast augmentation, breast reduction, and breast lift surgeries, to breast revision and breast reconstruction procedures. As a result, cosmetic plastic surgeons worldwide agree that preservation of the inframammary fold is important in all types of cosmetic breast procedures. However, if damage to the inframammary fold is unavoidable, surgeons take great care to resuspend it properly.

Learn more about Breast Surgery.

At Coco Ruby Clinic you’ll find plastic surgeons with years of experience, they take care in the placement of your inframammary fold during your breast surgery procedure, to bring you the results.

Inframammary Fold – What Is the IMF?

The inframammary fold (IMF), also known as the inframammary crease or inframammary line is the border where your lower breast and chest meet. The location of the resulting groove is at the level of your fifth rib, extending downward to reach your sixth intercostal space (space between your sixth and seventh rib). The inframammary fold is undetectable during your childhood years and only comes to define the lower aspect of your breasts when you reach puberty.

Although the importance of the inframammary fold in cosmetic breast plastic surgery is well accepted, its anatomy remains a topic of controversy among plastic surgeons. Some consider the inframammary crease as a ligamentous structure that extends from your fifth rib and inserts into the inner layer of the overlying skin (dermis). Whilst, others disagree and prefer to classify it as a specialised interwoven network of collagen fibres. These fibres support your inframammary skin fold by adhering to a condensed superficial covering of connective tissue (fascia).

Regardless of its correct anatomical description, the inframammary fold is a defining feature in a woman’s breast shape and structure.

Anatomy of The Inframammary Fold and Its Importance in Cosmetic Breast Surgery Blog on Coco Ruby Plastic Surgery- Breast Cross Section Illustration

Credits to User: Mikael Häggström, Public domain, via Wikimedia Commons

Inframammary Incision for Breast Surgery

The inframammary incision is a surgical incision made either along or underneath your existing inframammary crease. It’s the most common type of incision in both breast augmentation and breast reconstruction procedures. In fact, survey studies show more than 83.9% of plastic surgeons prefer this approach.

The advantages of an inframammary incision include;

  • Direct visualisation of the breast tissue and pocket
  • Inframammary fold hides postoperative scarring
  • Ability to reuse the same surgical incision location in revisional surgery
  • And, more.

Your Inframammary Fold – Why Is It Important?

The inframammary fold serves as an important anatomical, functional, and surgical landmark for cosmetic plastic surgeons performing cosmetic breast surgery, be it breast augmentation, breast reduction, breast lift, breast revision or reconstruction procedure.

1. Breast Augmentation

A surgical incision within the inframammary fold offers a versatile wide access point for your plastic surgeon to place any type of breast implant, especially those larger in size, with precision. It allows for minimal breast tissue dissection, faster healing, and unnoticeable breast augmentation scarring concealed within the fold.

For aesthetic results and minimal risk of implant malposition, careful surgical closure and stabilisation of your inframammary fold are necessary during your breast augmentation procedure.

2. Breast Reduction

Breast reduction or reduction mammaplasty are common plastic surgeries for women suffering from chronic neck, shoulder, and back pain or women who find physical activity difficult due to large heavy breasts. The majority of breast reduction surgeries employ the inframammary crease incision for premium results.

  • Vertical or lollipop breast reduction involves two incision sites, one around your areola (pigmented area around the nipple) and the second is a vertical line running from the lower edge of your areola to your inframammary line. It’s for those who want a moderate breast reduction.
  • The inverted-T breast reduction or Anchor technique also heavily relies on your inframammary fold as a surgery marker. Two incisions are made both vertically from the areola to your inframammary crease, and along the inframammary fold as well. A third surgical incision is also placed around the areola.

The access provided by the inframammary fold allows for a maximal degree of tissue removal and reshaping, ideal for those seeking significant breast reduction.

3. Breast Lift

Plastic surgeons utilize the inframammary line as a tool to assess the varying degrees of breast ptosis, allowing them to determine the breast lift (mastopexy) option for you.

A breast has the nipple and tissue mound lying above the inframammary crease, while in ptotic breasts:

  • Grade I (mild ptosis): Nipple lies at the level of the inframammary fold, above the lower contour of your breast
  • Grade II (moderate ptosis): Nipple lies below the inframammary fold, but still above the lower contour of your breast
  • And, Grade III (severe ptosis): Nipple lies below the inframammary fold, at the lower contour of your breast
  • Pseudoptosis: Majority of your breast mound lies below the inframammary fold, but the nipple remains above it

4. Breast Revision

Breast implant revision surgery is a complex procedure that involves the removal or replacement of your current breast implants. Women undergo breast revision surgery to change the size or type of their implants, or to correct complications from primary breast augmentation procedures such as implant malposition.

Overenthusiastic dissection of the inframammary fold is one of the most common causes of implant malposition. The popcorn technique or capsulorrhaphy is a method used to reduce the size of your implant pocket capsule. The capsule is the scar tissue layer formed around your breast implant. It’s your body’s automatic response to foreign objects and a normal part of your healing process.

The popcorn technique involves scorching the implant capsule with scattered small burns causing the capsule to shrink. Tightening of your implant capsule pocket and the new scar formation fixes your breast implants in place and prevents any future implant malposition or displacement. The popcorn technique gets its name from the snap and pop sound produced by the cautery tool used.

How Inframammary Fold Reconstruction works

The inframammary fold is one of the most difficult anatomical breast structures to recreate. However, it’s an obligatory step in breast reconstruction surgery as it determines your final aesthetic results. An ideal restored or reconstructed IMF should be well-defined, symmetrical to the contralateral breast, and has a sharp breast-chest angle.

Preoperatively, your plastic surgeon will mark out your new inframammary crease line while you’re in a standing position. There, they will perform a surgical incision during your breast reconstruction procedure. Furthermore, after breast pocket dissection and implant placement are done, sutures will be placed to close off your breast pocket and reinforce your inframammary fold. The technique used in IMF reconstruction will depend on your;

Inframammary Fold Malposition – Mistakes Surgeon can make with the IMF

In cosmetic breast procedures, plastic surgeons frequently need to raise or lower your inframammary fold depending on the type of cosmetic breast surgery being done. For example, Breast augmentation usually requires your inframammary crease to be at a lower position to recruit more skin to accommodate your new breast implants. Whereas, Mastopexy and reduction mammaplasty on the other hand require the inframammary fold to be elevated.

Low Positioning – IMF too Low

Lowering the inframammary line is almost a routine step while performing breast enlargement surgery. However, if you have ptotic or tuberous breasts, improper lowering of your inframammary fold may result in low-lying breasts. It can also result in a double bubble deformity.

So, what causes a double-bubble?

It is a result of lowering your inframammary crease, without your plastic surgeon completely removing or obliterating your preexisting one. In such scenarios, your implants may descend, and leave your previous IMF intact, unstretched and visible. Low hanging breast tissue (due to ageing, pregnancy, or weight gain) can also cause a double bubble deformity over your original inframammary line, while your breast implants remain in their original position. This creates what appears to be a second bulge beneath your breast, hence the ‘double bubble’ description.

High Positioning – IMF too High

Positioning the inframammary crease higher is not uncommon during breast lift and breast reduction procedures. However, if your plastic surgeon lifts your inframammary fold too high from its location, you may end up with high riding breasts. And If the inframammary crease was positioned at the level of your nipple or higher, your breast may acquire “a ball in a sock” appearance. In other words, it has upper breast fullness with a down-pointing nipple.

Medical Sources about Inframammary Fold or IMF

Specialist Plastic Surgeons and ENT (Ear, Nose and Throat) Surgeon

With a wealth of experience and training, our Specialist Plastic and ENT (Ear, Nose and Throat) Surgeons are dedicated to best-practice patient care and education, customising Surgery for each and every patient to best meet their needs and desired surgical outcomes.

Dr Craig Rubinstein
Dr Broughton Snell
Dr Stephen Kleid
Dr Gary Kode

Specialist Plastic Surgeon MED0001124843

Dr Craig Rubinstein

Dr Craig Rubinstein is a Specialist Plastic Surgeon based in Hawthorn East, Melbourne. With over 20 years of surgical experience especially in all areas of Cosmetic and Plastic Surgery, but particularly in breast surgery. These include Breast Augmentation and Breast Reduction as well as Breast Surgery Revision.

Furthermore, he believes that surgical customisation, precision planning and technical expertise help him to provide optimal surgical outcomes for his patients.

Specialist Plastic Surgeon MED0001190266

Dr Broughton Snell

Dr Broughton Snell is a Specialist Plastic and Reconstructive Surgeon based in Melbourne, Victoria, Australia. His training in Plastic Surgery took place in Australia and the United States of America (USA).

Dr Snell is a fully qualified specialist plastic surgeon having completed his Fellowship with the Royal Australasian College of Surgeons in plastic and reconstructive surgery.

ENT (Ear, Nose and Throat) Surgeon MED0001052799

Dr Stephen Kleid

Dr Stephen Kleid is an experienced Ear, Nose and Throat (ENT) Surgeon (Otolaryngologist) based in Melbourne with a passion for Septo-rhinoplasty, Septoplasty, as well as, a strong interest in Rhinoplasty Revision.

Dr Kleid trained at Melbourne University, then completed surgical training at various hospitals including Royal Melbourne, Royal Children’s, The Eye and Ear and St Vincents. He worked as a surgeon at the University of Florida Medical school for further experience.

Specialist Plastic Surgeon MED0001405964

Dr Gary Kode

Dr Gary Kode is a Specialist Plastic Surgeon, with experience in Aesthetic and Reconstructive Surgery, as well as non-surgical treatments.

Dr Kode is a member of several organisations, including the Australian Society of Aesthetic Plastic Surgeons (ASAPS), The International Confederation for Plastic and Reconstructive and Aesthetic Surgery, and he holds a Fellowship with the Royal Australasian College of Surgeons.

What to do next?

Our Patient Liaison Team can assist with any questions you may have when considering a procedure. You can send in an enquiry form below or call our Melbourne Clinic between 9 am – 5 pm Monday - Friday.

Disclaimer: Results depend on individual patient circumstances and can vary significantly. Results may also be impacted by a variety of factors including your lifestyle, weight, nutritional intake and overall health. Consult your Specialist Plastic Surgeon for details. This information is general in nature and is not intended to be medical advice nor does it constitute a doctor-patient relationship. Surgery risks and complications will be covered in detail during a consultation with your Surgeon.

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