title: A new method for inframammary fold recreation using a barbed suture.
abstract: BACKGROUND
  There are inherent limitations with previously reported inframammary fold (IMF) recreation methods. The IMF is firmly fixed to the chest wall, but not physiologically, and it is difficult to determine the correct IMF position in the supine position and in the absence of an implant.
  
  
  METHODS
  With our new IMF reconstruction method (i.e., drawstring method), the IMF is recreated by drawing a barbed suture, penetrating the dermis, along the IMF. The barbed suture is fixed to the costal cartilage at the medial IMF, and the head is drawn and cut externally at the lateral IMF. The IMF level and depth can be finely adjusted by the tension, in a seated position after implant insertion. Furthermore, the approach can be from a small incision, and a smooth IMF curve is reconstructed.
  
  
  RESULTS
  Our drawstring method was performed in 102 patients who underwent reconstruction using a breast implant (n = 95) or flap (n = 7). The mean patient age was 52.0 years (range 33-77 years) and the follow-up period was 12 months (range 3-18 months). Suture or implant infection or exposure did not occur. Suture slack occurred in ten patients with implant-based reconstruction; their IMF became shallow. Insufficient skin expansion (P < 0.005) and strong traction of the barbed suture from the caudal side (P < 0.05) were related to IMF slack. The total revision rate was 2.9 %.
  
  
  CONCLUSIONS
  With sufficient skin expansion, the drawstring method using a barbed suture enables smooth and symmetrical IMF reconstruction.
  
  
  METHODS
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authors.affiliation: Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan, y.terao@cick.jp.
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Terao
authors.forename: Koichiro
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Shoichi
authors.initials: S
authors.lastname: Tomita
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D061525:Perforator Flap / Q000098:blood supply* / Q000637:transplantation; D017568:Rectus Abdominis / Q000098:blood supply / Q000637:transplantation; D012189:Retrospective Studies; D018570:Risk Assessment; D013536:Suture Techniques; D013537:Sutures; D013997:Time Factors; D016896:Treatment Outcome