Aesthetic Plast Surg. 2026 Apr 8. doi: 10.1007/s00266-026-05811-5. Online ahead of print.
ABSTRACT
BACKGROUND: The inframammary fold (IMF) plays a central role in breast augmentation surgery, yet its long-term positional stability following implant placement remains insufficiently characterized. Accurate prediction of IMF location is essential for aesthetic outcomes, particularly when selecting surgical approaches or implant types.
METHODS: A retrospective observational study was conducted on 156 breasts (78 patients) who underwent augmentation between 2018 and 2022, with a minimum follow-up of 12 months. Pre- and postoperative measurements were obtained using 3D imaging in arm-adducted position. Variables included SN-Ni, Ni-Ni, Ni-IMF, SN-Nimid, Ni-IMFmid, and SN-IMFmid. Patients were stratified by implant shape (anatomic vs. round), placement plane (submuscular, subfascial, dual plane II), and incision type. Statistical analyses were performed to evaluate IMF displacement and associated factors.
RESULTS: The IMF was displaced by more than 10 mm from the planned position in 53.8% of cases. Anatomic implants demonstrated slightly less fold displacement than round implants (3 ± 14.7 mm vs. 8.1 ± 14 mm), although this was not statistically significant. Submuscular placement significantly increased lower pole expansion and IMF descent compared to subfascial placement (p < 0.05). There was no significant difference in fold stability based on incision type, including inframammary incisions where reinforcement sutures were used.
CONCLUSIONS: Caudal displacement of the IMF is common following breast augmentation. Submuscular placement contributes significantly to this effect. Anatomic implants may offer improved fold stability. Preoperative planning using the implant radius from the sternal midline is reliable. IMF reinforcement appears non-essential but warrants further study.
LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
PMID:41951896 | DOI:10.1007/s00266-026-05811-5
