Understanding the inframammary fold
The inframammary fold (IMF), also known as the breast crease, is a key anatomical landmark that separates the breast from the chest wall. This crease is formed by specialized collagen fibers within the skin and is a crucial element in defining the overall shape and aesthetic of the breast. Its position and definition are carefully considered by plastic surgeons during procedures like breast augmentation, reduction, and lifts to ensure a natural-looking outcome.
What is a high inframammary fold?
A high inframammary fold is a condition where the breast crease is located too high on the chest relative to the rest of the breast tissue. Instead of providing a defined and natural-looking lower border, it creates a distorted or unnatural breast contour. This can lead to a "high-riding" breast or a "ball in a sock" appearance, where the implant or breast tissue sits too high, and the nipple points downward.
Common causes of a high IMF
Complications from breast surgery
- Inadequate release: During breast augmentation, the implant pocket needs to be correctly sized and positioned. If the surgeon fails to adequately release the pectoralis muscle or the existing IMF during a submuscular implant placement, the muscle can hold the implant in a high position.
- Improper surgical technique: Inexperienced or poor surgical judgment can result in the IMF being repositioned too high during breast lifts (mastopexy) or reductions (mammaplasty), leading to a high-riding breast.
- Transaxillary approach: Using an incision through the armpit can increase the risk of implant malposition, including a high IMF, due to less direct visualization of the fold during the procedure.
Capsular contracture
Capsular contracture is the formation of a tight, restrictive scar tissue capsule around a breast implant. This hardened capsule can squeeze the implant, pushing it and the surrounding breast tissue upwards, leading to a high IMF and a hard, misshapen breast.
Congenital factors
Some individuals may naturally have a higher-than-average inframammary fold due to unique anatomical features. This is sometimes associated with a constricted lower breast pole or a tuberous breast deformity, where the lower part of the breast is tight and underdeveloped.
Double bubble deformity
One of the most common signs of a malpositioned high IMF after breast surgery is a double bubble deformity. This occurs when the newly created fold from the implant sits below the original, higher natural fold, resulting in two distinct curves or "bubbles" on the breast's lower pole.
Correcting a high inframammary fold
Correction for a high IMF is almost always surgical and is typically performed as a revisionary procedure. The specific technique depends on the underlying cause:
- Capsulotomy: If the high fold is caused by capsular contracture, the tight capsule must be released. A capsulotomy involves making an incision into the capsule to relax the scar tissue, allowing the implant to settle into a more natural position.
- Capsulorrhaphy: In cases of implant malposition, a capsulorrhaphy might be performed to tighten the implant pocket internally. This can secure the implant in a lower, more desired position.
- IMF release and re-suturing: For high folds caused by improper placement during a lift or reduction, the surgeon may release the fold and re-suture it at a lower level to recreate a more aesthetically pleasing crease.
- Fat grafting: To smooth the transition between the original, high IMF and the new fold created by an implant, fat grafting can be used. This involves injecting fat into the area to add volume and camouflage the deformity.
- Internal bra technique: This method provides internal support for the implant by suturing a biological mesh to the chest wall at the new inframammary fold, effectively creating an internal "hammock" to prevent the implant from riding high.
Comparison: High IMF vs. Low IMF
| Feature | High Inframammary Fold (IMF) | Low Inframammary Fold (IMF) |
|---|---|---|
| Appearance | Breasts appear high on the chest, often with a "ball in a sock" look and a downward-pointing nipple. May present as a "double bubble" deformity. | Also known as "bottoming out," where the breast implant and tissue sag below the natural crease. |
| Associated Issue | Often caused by capsular contracture, inadequate implant pocket release, or over-lifting during surgery. | Caused by weakened tissue support, aggressive dissection during augmentation, or overly large implants. |
| Correction | Surgical release of the capsule (capsulotomy) and re-positioning or re-suturing the fold. | Surgical tightening of the implant pocket (capsulorrhaphy) and reinforcement of the IMF. |
| Surgical Risk | Higher risk in patients with constricted lower poles or tuberous breasts. | Higher risk with overly large implants for the patient's anatomy. |
Conclusion
A high inframammary fold is a surgical complication or congenital condition that results in the breast crease being unnaturally elevated on the chest. While it can cause an aesthetically displeasing contour, the condition is treatable. Causes range from capsular contracture and improper surgical technique to specific anatomical factors. Corrective measures are surgical and include releasing the constrictive capsule or re-suturing the fold. For anyone concerned about a high IMF, consulting a board-certified plastic surgeon is essential to determine the best course of action for a natural and satisfactory result. Further research on surgical techniques for retaining the IMF can be found on reputable medical sites.
