The Inframammary Fold and the Role It Plays in Breast Surgery

The Inframammary Fold and the Role It Plays in Breast Surgery

You might have briefly heard or read about your inframammary fold if you have been researching breast surgery. In this article, we will discuss what the inframammary fold is and how it impacts breast surgery and surgery results. The inframammary fold plays a very important role in every kind of breast surgery. It is one of the most important elements of the overall aesthetic appearance of the breast. You may or may not have heard about the upper and lower poles of the breasts. These terms refer to the fullness of the top and bottom parts of the breast. These two elements are hugely impacted by the inframammary fold. Essentially, the inframammary fold is the part at the inferior or lower part of the breast, where your breast is attached to the chest.

Dr Jeremy Hunt is a Sydney specialist plastic surgeon who practices in Sydney and Wollongong. Dr Hunt has completed over a thousand breast surgeries in Australia.

What is an Inframammary Fold (IMF)?

The inframammary fold is discussed at every single breast surgery conference. It defines the lower pole of the breast. Any problems associated with inframammary fold essentially impacts how your breasts will look after the surgery. Clearly defining the fold is helpful. An inframammary fold that is either too low or too high can create many problems and complications.

Guide to Breast Surgery

Standard Breast Surgery

Different Types of Inframammary Folds (IMFs)

An experienced surgeon will take your breast anatomy into account. A simple test can determine what type of inframammary fold you have and what approach/technique should be employed to achieve the desired results. There are cases when lowering the inframammary fold can help the overall aesthetics outcome.Usually, a simple arm position test is enough. It is a great way to identify problematic folds.

4 types of IMFs defined by Surgeons

  • Type 0: it is a non-existent fold. This category defines the patient who has very hard to see inframammary fold. Think of it as a blank canvas or a blank palette. It gives surgeons the opportunity to create an inframammary fold themselves. Essentially, Dr Hunt will determine where to end the breast and start the waist. In this case, Dr Hunt can lower the fold as well because there is no native fold.
  • Type 1: this is the type of fold which is visible when people have their arms by their sides. However, as soon as the person lifts their hands up, the fold disappears completely and isn’t visible. It is generally a very safe fold when it comes to breast surgeries. Modern technology and cohesive gel will help efface the fold.
  • Type 2: it is definitely a tricky fold. This is moderately prominent. However, you cannot spot the fold unless the person lifts their arms. You can almost put a number to it: 50% effacement and 50% less dominant or less present. These folds can be lowered but the surgeon needs to be cautious. Dr Hunt might use a fat graft for a better result. Most surgeons would keep lowering it to the minimum, around less than 2cm. it is important to customise the dual plane interface to ensure the fold is gone and there isn’t any muscle covering it up.
  • Type 3: this is certainly a hard one and you need a surgeon to detect it for you. It essentially looks like any other normal fold but as soon as the person lifts their arms up, there is absolutely no change in the fold.

The fold will raise up in the same way as it was before. These folds can be deemed problematic. They can be lowered if the surgery calls for it. However, there is a high risk involved. If the fold isn’t lowered correctly, it can lead to double bubble deformity. Dr Hunt would advise you against lowering this type of fold as there is a high risk involved.

Every Breast Surgery Patient is Different

Every single patient is different. An individual with small breasts will have less distance from the nipple to the inframammary fold that someone with larger breasts. If the surgeon doesn’t lower the inframammary fold prior to making an incision for implant insertion, the scar can end up showing itself on the actual breast with the increase in breast enlargement. Lowering the inframammary fold will create the desired space for implants and the scar will be concealed underneath the breast instead of sitting on top of your breasts.

Every single person is different when it comes to the size and shape of their breasts and what they want from their surgery. Selecting the right surgeon for your breast surgery is critical. It is crucial for the plastic surgeon to understand different approaches as well as techniques to suit the needs of every single patient.

Selecting any doctor who believes in one size fits all approach can bring you closer to a breast surgery disaster. If you don’t want to end up with unsatisfactory results, invest some time in selecting the right surgeon who has years of experience in performing breast surgery procedures.

Key Elements of Breast Anatomy

Regardless of the type of breast surgery you are considering, your surgeon will examine your breasts and explain to you in detail how surgery can help get the results you want.

Learning about the inframammary fold, details about your breast anatomy along with common breast terms will enable you to understand and communicate with your surgeon in a better way. We have discussed the inframammary fold in detail. Now, let’s move to breast anatomy.

Developmental Formation of Breasts

Until you hit puberty, your breasts won’t look much different from the breasts of a boy. Until this point, the chest of boys and girls look very similar. Once you hit puberty, the hormonal changes stimulate the development of breasts and the breast tissue starts to grow and change in terms of size and shape for women. Throughout puberty, your nipples will become erect, areolas will become pigmented, rounder, and darker, and your breasts will become larger.

Typically, breasts will stop growing and mature by the time you reach the age of 18 years old. That doesn’t mean that your breasts will stay the same throughout life. Many factors impact the shape and size of your breasts throughout your life: skin elasticity, menstrual cycle, breastfeeding, weight gain, weight loss, ageing, and other lifestyle factors.

What are Your Breasts Made Of?

The anatomy of breasts is quite complex. Breasts consist of 3 main types of tissues: glandular, connective, and fat. Let’s discuss these elements briefly:

  • Glandular Tissue: this particular area is essentially responsible for breast milk production. Lobes along with tubes carry the milk to your ducts
  • Fat Tissue: it is essentially responsible for giving your breasts their size known as the adipose tissue
  • Connective Tissue: these tissues are essentially responsible for holding everything together and are responsible for giving their breasts the desired form and shape. Cooper ligaments are an important element of the connective tissues

Other Breast Features

We have discussed what the inframammary fold is, what your breasts are made up of, let’s dive deeper into the anatomy of the breasts.

Breasts essentially overlay the chest wall muscles. These chest wall muscles are known as pectoral muscles. There are two muscle layers. The inner layer is known as the pectoralis minor and the outer layer is called the pectoralis major. These muscles sit on your ribs. They are covered by fascia which is a thin layer of fibrous tissue. If the surgeon places the implants underneath the pectoral muscles, it is known as submuscular placement. It is typically the most common technique – under the muscle or dual plane.

The glandular tissue is generally organised into 15-20 lobes of the breast. Each of these lobes is made of many smaller tissues that are called lobules. These glands are responsible for breast milk production. Expect them to feel a little harder than the fat tissue surrounding them. A network of small ducts runs between the glands that are responsible for milk transportation to the nipples.

Breast Fat that surrounds the glandular tissue will give the breast its size. The tissue carries many veins and arteries along with lymph nodes and vessels. The connective tissue runs through the breast to offer support to the structure, Cooper ligaments are the key component of the connective tissue. These ligaments are an intricate web of thin but intense cords that run through the breasts. Moreover, cooper’s ligaments are very important when it comes to keeping your breasts firm and perky. Stretching of cooper ligaments will eventually lead to saggy boobs.

Breast Augmentation Mammoplasty Incision Placement Options

During your pre-operative appointment, it is important to discuss the following incision placement options with your plastic surgeon:

The most common – Inframammary Incision

As very self-explanatory from the name, the inframammary incision is a short incision that is made in the crease underneath your breast. This scar is typically very thin and usually around 3 to 6 cm long depending on implant size. This technique is beneficial for concealing the scar and allows Dr Hunt to place larger implants with more precision. This incision will allow for sub-glandular (over the muscle) placement of implants along with subpectoral or submuscular (under the muscle) placement.

Other less likely choices include Periareolar Incision and Transaxillary Incision

Having basic knowledge about anatomy and breast surgery options will help you communicate with your surgeon in an effective manner and enable you to understand your implant placement options. It will also help you understand how your surgeon can modify your surgery with regard to the type of inframammary fold you have.

Further Reading about Breast Implant Surgery

Medical References about the Inframammary Fold

About Dr Jeremy Hunt – Specialist Plastic Surgeon

dr jeremy hunt

Dr Jeremy Hunt is a specialist plastic surgeon performing breast, body, face and nose surgery. He is a member of FRACS & ASPS and has over 20 years of experience providing plastic surgery in Sydney.

Dr Hunt’s personal, one-on-one service and attention to detail has ensured that thousands of women and men from the Sydney & Wollongong NSW area and across Australia have received high quality surgical care.

Dr Hunt’s qualifications and education

Dr Jeremy A Hunt MBBS FRACS graduated with a Bachelor of Medicine degree from Sydney University in 1990 and is a Fellow of the Royal Australasian College of Surgeons and member of the Australian Society of Plastic Surgery. He completed a Fellowship at the prestigious University of Texas in the United States, where he learnt from some of the world’s very best plastic surgeons.

Next Step – Make an Enquiry or Request a consultation with Dr Hunt

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About The Author

Dr Jeremy Hunt FRACS - Specialist Plastic Surgeon

Dr Jeremy Hunt is one of Australia’s leading specialist plastic surgeons. With over 20 years’ experience and thousands of patients, Dr Hunt is the smart choice for your plastic surgery or non-surgical procedure.

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