Lateral Inframammary Approach for Asian Augmentation Mammaplasty

Abstract

Background: The inframammary fold (IMF) approach for augmentation mammaplasty is less popular in Asia. The incision was modified to lateral IMF(L-IMF) for easy access and better outcome. The aim of this study was to evaluate if L-IMF approach is feasible in Asian women.

Methods: Between 2002 and 2016, 53 patients with 96 augmentation mammaplasties were performed using lateral (L-IMF, 31 cases, 56 breasts) and traditional IMF approaches (T-IMF, 22 cases, 40 breasts). Surgical outcome was compared between L-IMF and T-IMF groups. Scar was assessed using photographic images by 4 assessors with a modified Manchester Scar Score, and telephone surveys available in L-IMF group.

Results: The average age was 41 ± 10.7 years (range, 20-73 years). There were no statistical differences in demographics in both groups besides of implant type (P < 0.01). At a follow-up of 80.1 months (range, 20-173 months), the capsular contracture rate and overall complication rate were statistically lower in L-IMF group, 3.6%, and 3.6%, than in T-IMF group, 15%, and 20% (P = 0.05, and P < 0.01, respectively). The modified Manchester Scar for L-IMF scars was 8.47 ± 2.4. The average score of 24 of 31 patients with L-IMF incision was 3.8 ± 0.96/5 points with patient-reported questionnaire. Nineteen patients (79.2%) would recommend or strongly recommend the procedure to friends.

Conclusions: The scar of L-IMF group healed satisfactorily with lower capsular contracture and overall complication rates than T-IMF group. Patients were satisfied with the outcome of breast augmentation and scar appearance using L-IMF approach.

Fig. 1.

Between the “4–5” or “7–8” o’clock positions of the left or right IMF marking, a 3-cm incision was adequate for saline implants. The incision was 4 cm for primary augmentation, and 5 cm for revision augmentation using silicon implant. The new IMF was set at 7 cm inferior to nipple at 6 o’clock. IMF, inframammary fold.

Fig. 2.

Preoperative (A) and 36 months’ postoperative (B–D) photographs. The 35-year-old woman who underwent primary breast augmentations. The L-IMF incision 4 cm was made. Bilateral smooth silicon implants 300 cc were inserted. Fixation of new IMF-7 cm away from nipple was made. IMF, inframammary fold.

Fig. 3.

Preoperative (A) and 11 months’ postoperative (B–D) photographs. The 45-year-old woman who underwent primary breast augmentations. Via L-IMF incision was made. Bilateral smooth silicon implants 300 cc were inserted and bilateral nipple retractions were released. IMF, inframammary fold.

Fig. 4.

Preoperative (A) and 10 months’ postoperative (B–D) photographs. The 41-year-old woman who underwent primary breast augmentations. Via L-IMF incision was made. Right side smooth silicon implant 240 cc and left side with 200 cc were inserted and bilateral nipple retractions were released. IMF, inframammary fold.