A simple guide to inframammary-fold reconstruction

In breast reconstruction, the inframammary fold (IMF) is one of the most difficult anatomic structures to faithfully recreate. Nonetheless, it is critical to achieving optimal aesthetic outcome. We describe our technique for reconstructing the IMF as a secondary procedure after breast reconstruction using a Steinman pin template based on the curvature of the normal contralateral IMF. Twelve cases of IMF reconstruction using this technique have been performed with good aesthetic outcome and high reliability, with the longest follow-up being over 10 years. Advantages include (1) use of the Steinman pin template based on the contralateral side maximizes attainable symmetry, (2) an additional incision is not required, (3) precise suture placement is facilitated by visualization of the pin inside the breast cavity, and (4) use of a running internal mattress suture avoids a scalloped appearance, and smooth curvature of the IMF over its entire width is easily and reliably obtained. This technique is applicable to postoperative deformities from breast reconstruction using flaps, implants, or both.