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

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.