title: Inframammary Fold Reconstruction: A Biomechanical Analysis.
abstract: BACKGROUND
  Inframammary fold reconstruction has scarcely been evaluated in literature. No biomechanical analyses have been performed comparing different reconstructive methods. This evaluation compares the gold-standard suture reconstruction with an intrarib anchor system (Micro BioComposite SutureTak, Arthrex).
  
  
  METHODS
  Three analysis groups were compared including 8 Sawbone blocks, 22 embalmed cadaver, and 27 regular cadaver specimens (N = 57). Transient mechanical analysis was performed at 5 N/s using an Instron 5565 test frame.
  
  
  RESULTS
  Ultimate load favored the anchor system (compared with the gold-standard suture) by a factor of 9.8 (P < 0.0001) for the regular cadaver group and a factor of 1.7 (P < 0.038) for the embalmed cadaver group. A similar statistically significant benefit was shown for stiffness and load at 2-mm displacement.
  
  
  CONCLUSIONS
  This analysis showed an anchor system to be the biomechanically superior fixation method in terms of ultimate load, fixation stiffness, and displacement at failure when compared with the gold-standard suture method in inframammary fold reconstruction. Because of superior stability in every aspect, an anchor system may be considered for inframammary fold reconstruction.
authors.affiliation: Brustzentrum, Municipal Hospital Holweide, Cologne, Germany; Department of Gynecology and Obstetrics, Municipal Hospital Holweide, Cologne, Germany; Department of Radiology, Municipal Hospital Holweide, Cologne, Germany; Department of Anatomy, RWTH Aachen University, Aachen, Germany; Department of Anatomy II, University of Cologne, Cologne, Germany; and Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Eichler
authors.affiliation: Brustzentrum, Municipal Hospital Holweide, Cologne, Germany; Department of Gynecology and Obstetrics, Municipal Hospital Holweide, Cologne, Germany; Department of Radiology, Municipal Hospital Holweide, Cologne, Germany; Department of Anatomy, RWTH Aachen University, Aachen, Germany; Department of Anatomy II, University of Cologne, Cologne, Germany; and Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Schell
authors.affiliation: Brustzentrum, Municipal Hospital Holweide, Cologne, Germany; Department of Gynecology and Obstetrics, Municipal Hospital Holweide, Cologne, Germany; Department of Radiology, Municipal Hospital Holweide, Cologne, Germany; Department of Anatomy, RWTH Aachen University, Aachen, Germany; Department of Anatomy II, University of Cologne, Cologne, Germany; and Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Uener
authors.affiliation: Brustzentrum, Municipal Hospital Holweide, Cologne, Germany; Department of Gynecology and Obstetrics, Municipal Hospital Holweide, Cologne, Germany; Department of Radiology, Municipal Hospital Holweide, Cologne, Germany; Department of Anatomy, RWTH Aachen University, Aachen, Germany; Department of Anatomy II, University of Cologne, Cologne, Germany; and Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Prescher
authors.affiliation: Brustzentrum, Municipal Hospital Holweide, Cologne, Germany; Department of Gynecology and Obstetrics, Municipal Hospital Holweide, Cologne, Germany; Department of Radiology, Municipal Hospital Holweide, Cologne, Germany; Department of Anatomy, RWTH Aachen University, Aachen, Germany; Department of Anatomy II, University of Cologne, Cologne, Germany; and Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Scaal
authors.affiliation: Brustzentrum, Municipal Hospital Holweide, Cologne, Germany; Department of Gynecology and Obstetrics, Municipal Hospital Holweide, Cologne, Germany; Department of Radiology, Municipal Hospital Holweide, Cologne, Germany; Department of Anatomy, RWTH Aachen University, Aachen, Germany; Department of Anatomy II, University of Cologne, Cologne, Germany; and Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Puppe
authors.affiliation: Brustzentrum, Municipal Hospital Holweide, Cologne, Germany; Department of Gynecology and Obstetrics, Municipal Hospital Holweide, Cologne, Germany; Department of Radiology, Municipal Hospital Holweide, Cologne, Germany; Department of Anatomy, RWTH Aachen University, Aachen, Germany; Department of Anatomy II, University of Cologne, Cologne, Germany; and Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Warm