# The inframammary fold: Structure, clinical considerations, and reconstructive techniques

## TL;DR

This paper reviews the inframammary fold's anatomy and surgical reconstruction techniques, highlighting challenges and current methods.

## Contribution

The paper provides a comprehensive review of inframammary fold reconstruction techniques and their clinical implications.

## Key findings

- The inframammary fold's anatomy and structure are debated in the literature.
- Current reconstructive techniques lack direct comparison and rely on low-level evidence.
- Challenges in reconstruction include gender-affirming surgery and fold insufficiencies.

## Abstract

The inframammary fold is a defining structure of breast position and form. Disruption, relocation and reconstruction of the Inframammary fold is therefore significant and may present surgical challenges. Furthermore, the inframammary fold’s anatomy, structure, relationship to other key thoracic landmarks and how these factors impact reconstruction is debated in the literature.

Several reconstructive techniques have been proposed since the IMF was first described as a distinct structure. These are commonly used in isolation or in combination, however there is a lack of direct comparison between different reconstruction methods. Much of the current literature is based on level IV or level V evidence often with small sample sizes.

The inframammary fold’s anatomy is discussed in this review on a macro- and microscopic level. Indications and procedures for inframammary fold reconstruction are discussed. The distinct challenges presented by different reconstructive techniques, gender-affirming surgery, inframammary fold insufficiencies and pathologies are considered.