Home   |   Contact Us   |  Application for Membership    |   Bylaws of ASCBS    |  Surgery Photos   |    Workshop Registration  |   Members   |   Associate Fellows   |    Fellows  
 Program2006   |  Program2007   |  Program 2008  |  Program 2009   Program 2010   Program 2011  Program 2012 | 
Program 2013  l Program 2014  Program 2015 | Program 2016 | Program 2017 | Program 2018

 

Nature tends to want to go back the way it was. Therefore it is expected that the IMF area will heal back more densely than the superior areas surrounding the implants, thus pushing the implants up with capsule contracture. Capsule contracture causes the implants to rise up on the chest.

Capsule contraction begins in this lower area of the pocket. It is the healing down of the previous IMF that has been dissected up and pressed out to accommodate the implant. As the capsule forms, the implant is pushed up. It may be because of exposure of the deep dermis with the stretching out of the previous IMF that this tends to want to heal back.

Fig. 3

The nipple pointing down in #1 is converted to a more desirable appearance in #3 by lowering the IMF and perhaps using a larger implant to fill the new volume below the nipple created. In #2, the IMF has been lowered, but a double fold remains. This is the original IMF that has not been pressed out. These implants are below the muscle.

A textured McGhan implant will not move down and press it out.  It remains with adherence, like Velcro , where it is placed. Sometimes with a smooth implant, gravity and pressure, especially if under the muscle, will correct a minor double fold. The presence of steroid also will help and prevent rapid healing and worsening of the double fold appearance.

2. The importance of the new IMF position

The inframammary fold (IMF) also warrants discussion because the management of this area is the key to an attractive shape in many cases.

A larger implant requires more lowering of the IMF. If the IMF is not low enough, the implant will appear too high. The implant should appear to be centered behind the nipple while on the table and with the head of the table elevated to a sitting position.

 

In the breast with ptosis or pseudoptosis, the position of the IMF and implant size are critical to the appearance. The "ball-in-a-sock" and down pointing nipple result when the fold is not lowered, and can often be corrected by lowering the fold.

The "double-bubble", or double fold, is the persistence of the previous IMF. This can occur with all incisions and either above or below the muscle.

Some of the important effects of the inframammary position and IMF dissection are:

            1. Too high or too low appearance

            2. Direction of nipple pointing

            3. Double fold or double-bubble

            4. Synmastia or uni-breast

            5. Ptosis and pendulous breast

            6. Implant size

            7. Capsule contraction

            7. Palpability of the implant

            8. Ball in the sock appearance

            9. The breast shape

           10. The curve of the CN and NC lines. (clavicle-nipple=CN, nipple-chest=NC - profile lines)

           11. Asymmetry

At surgery some common important considerations to observe and correct if possible are

     1. Too high

     2. Too low

     3. Unequal - asymmetrical

     4. Cleavage

     5. Size

     6, Persistent original IMF  -  double bubble

     7. Pointing direction

     8. Implant centering

     9. Feel to palpation

    10. Flow with movement and position change

    11. Shape front and profile

Page 1    Page 2    Page 3

 
Home   |   Contact Us   |  Application for Membership    |   Bylaws of ASCBS    |  Surgery Photos   |    Workshop Registration  |   Members   |   Associate Fellows   |    Fellows  
 Program2006   |  Program2007   |  Program 2008  |  Program 2009   Program 2010   Program 2011  Program 2012 | 
Program 2013  l Program 2014  Program 2015 | Program 2016 | Program 2017 | Program 2018

The American Society of Cosmetic Breast Surgery 2017    Last modified: June 23, 2017