Inferior mammary fold reconstruction in reconstructed breast: a novel technique

Yasser Hijazi, Mark Brewin, Caroline McGuiness


Background: In breast reconstructive surgery, the infra-mammary fold (IMF) is an integral component of breast identity. The distortion of the IMF during breast surgery or reconstruction following mastectomy often requires restoration. We have developed a new IMF reconstruction technique using de-epithelialised dermis secured to the periosteum of the rib. This acts as a hammock to support the breast tissue in the new position. This paper presents our nine-year experience of performing this original technique following free tissue transfer or tissue expanders (TEs) to reconstruct the breast post-mastectomy.
Methods: Pre-operatively, the new IMF line is marked out while the patient is in a standing position. Two centimeters of the lower border of the reconstructed breast is de-epithelialised. The pectoralis major fascia is accessed through the dermis and the lower third of the flap is raised and folded in upwards. The dermis is then stitched to the periosteum of the rib at the desired higher level using interrupted 2/0 polydioxanone (PDS) sutures; thus, creating the new IMF.
Results: A total of 9 patients were included in this report. The average age was 49 years (range, 31–61 years). Two cases had bilateral subcutaneous mastectomy and deep inferior epigastric perforator (DIEP) flap reconstruction. One case had immediate DIEP on one side and delayed DIEP on the other. One case had bilateral delayed DIEP. Two cases had unilateral delayed DIEP reconstruction following oncological mastectomy. Three cases were following TEs in unilateral breast reconstruction one of which had a high IMF that needed lowering. IMF in all cases was recreated using the same technique; each achieving a satisfactory outcome with no complications recorded.
Conclusions: This technique provides the reconstructed breast with a well-defined IMF and improves its projection. The results are long-lasting and provide a sharp breast-thoracic angle, which is fundamental in the creation of a natural-looking reconstructed breast.