title: Augmentation mammaplasty: enhancing inferomedial cleavage.
abstract: BACKGROUND
  Typically, symmetrical markings are made to lower the inframammary fold (IMF) according to the surgeon's judgment. Because inferomedial fascial attachments of the IMF may at times compromise the proper seating of the implant in this area, causing excessive superior projection, asymmetrical lowering of the IMF is performed to allow for increased lowering of the inferomedial aspect of the fold.
  
  
  OBJECTIVE
  A technique for enhancing inferomedial cleavage in augmentation mammaplasty is presented, and the frequency and value of the procedure in a series of patients is assessed.
  
  
  METHODS
  A retrospective chart review was performed of 267 patients who underwent subpectoral augmentation mammaplasty using inflatable implants between November 2001 and March 2005. In cases involving lowering of the IMF, a combination of blunt and sharp dissection was performed to release the IMF in the inferomedial area and lower the inferomedial aspect of the fold, tapering to less lowering centrally and minimal to no change laterally.
  
  
  RESULTS
  Among the 267 cases reviewed, 225 patients (84%) underwent some form of IMF lowering, of whom 191 (71%) underwent asymmetric lowering of the IMF to enhance inferomedial cleavage. Complications included 4 patients who required revision to correct bottoming out and 1 case of hematoma.
  
  
  CONCLUSIONS
  Increased lowering of the inferomedial portion of the inframammary fold is helpful in correction of constriction of the inferior pole and/or lateral flare of the breasts. This technique is also suitable for patients who desire to enhance the inferomedial cleavage area and is of value for patients requesting larger implants.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Pacik