title: Aesthetic outcomes of inframammary fold recreation in two-stage, implant-based, breast reconstruction.
abstract: BACKGROUND
  When the inframammary fold (IMF) is excised in mastectomy procedures for oncologic reasons, it must be recreated to restore a natural breast shape. Despite refinements in surgical techniques, postoperative loss of a well-defined IMF can occur. This study aimed to assess the outcomes of IMF recreation after two-stage, implant-based breast reconstruction.
  
  
  METHODS
  We retrospectively reviewed 75 consecutive patients who underwent unilateral, two-stage, implant-based breast reconstruction between 2013 and 2015 at the authors' institution. Among them, IMF recreation was performed in 37 patients through a modified Nava's internal method. Aesthetic outcomes of the recreated IMFs were evaluated by observer assessment of two criteria, and critical factors affecting IMF outcomes were also analyzed.
  
  
  RESULTS
  We found that contralateral breast ptosis (p < 0.05) and lack of postmastectomy radiotherapy (PMRT, p < 0.01) were significant predictors of better IMF outcomes. Nipple-sparing mastectomy and skin-sparing mastectomy resulted in better IMF outcomes, as compared with non-skin-sparing mastectomy (p < 0.05 for each), while no significant difference was observed between them in patients who did not undergo PMRT (p = 0.19). Similarly, larger implant volume, but not projection of implant, was a predictor of better IMF outcomes when limited to patients who did not undergo PMRT (p < 0.05). Age, body mass index, timing of reconstruction, and extent of overexpansion had no significant effect on IMF outcomes.
  
  
  CONCLUSIONS
  Based on these critical factors, the shape of the reconstructed breast and the need for reshaping the contralateral breast can be predicted. Special attention should be paid to patients with non-skin-sparing mastectomy and PMRT. When these patients desire a medium- to large-sized ptotic breast, conversion to autologous reconstruction can achieve symmetrical breast reconstruction.
authors.affiliation: Department of Plastic Surgery and Reconstructive Surgery, Osaka University Graduate School of Medicine, 2-2 C11 Yamadaoka, Suita, Osaka 565-0871 Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Tomita
authors.affiliation: Department of Plastic Surgery and Reconstructive Surgery, Osaka University Graduate School of Medicine, 2-2 C11 Yamadaoka, Suita, Osaka 565-0871 Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yano
authors.affiliation: Department of Plastic Surgery and Reconstructive Surgery, Osaka University Graduate School of Medicine, 2-2 C11 Yamadaoka, Suita, Osaka 565-0871 Japan.
authors.forename: Akimitsu
authors.initials: A
authors.lastname: Nishibayashi
authors.affiliation: Department of Plastic Surgery and Reconstructive Surgery, Osaka University Graduate School of Medicine, 2-2 C11 Yamadaoka, Suita, Osaka 565-0871 Japan.
authors.forename: Shien
authors.initials: S
authors.lastname: Seike
authors.affiliation: Department of Plastic Surgery and Reconstructive Surgery, Osaka University Graduate School of Medicine, 2-2 C11 Yamadaoka, Suita, Osaka 565-0871 Japan.
authors.forename: Ko
authors.initials: K
authors.lastname: Hosokawa
keywords: Aesthetic outcome; Breast reconstruction; Implant; Inframammary fold