From the Breast Academy; and private practice.
Plast Reconstr Surg. 2021 Dec 1;148(6):903e-914e. doi: 10.1097/PRS.0000000000008563.
Previous aesthetic breast surgery algorithms have not addressed the importance of evaluating the native inframammary fold before primary breast augmentation. In the authors' experience, assessment of native inframammary fold anatomy significantly impacts surgical planning and technique. Failure to adequately evaluate and manage the inframammary fold leads to many of the common problems of the lower pole, including double-bubble deformity.
The authors assessed the inframammary fold preoperatively in 2192 consecutive patients undergoing primary breast augmentation between June of 2014 and December of 2018. A novel classification of inframammary fold morphology was devised based on review of standardized preoperative photographs. Outcome assessment was performed postoperatively at 3-month intervals.
The authors identified four clear inframammary fold subtypes based on their clinical appearance, ranging from the nonexistent type F0 to the well-formed and fixed type F3. The key outcome measure examined was the presence of double-bubble deformity postoperatively. There were three total cases of double-bubble deformity identified in our cohort (<1 percent of patients). All cases of double-bubble deformity occurred in patients with a type 3 fold.
The inframammary fold defines the inferior boundary of the lower pole of the breast and is a critical landmark to the aesthetic breast surgeon. The authors describe a unique and simple inframammary fold classification system that assists in selection of the appropriate approach to the inframammary fold in addition to implant dimensional planning. The authors have found that this system-in particular, the identification of the type F3 inframammary fold-has minimized the risk of inframammary fold-associated complications in over 2000 cases.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
以前的美容乳房手术算法没有涉及到在初次乳房增大之前评估原生乳晕折叠的重要性。在作者的经验中，评估原生乳晕折叠解剖结构会显著影响手术计划和技术。如果不能充分评估和管理乳晕折叠，会导致许多常见的下极问题，包括双泡畸形。
作者在 2014 年 6 月至 2018 年 12 月期间对 2192 例连续行初次乳房增大术的患者进行了术前乳晕折叠评估。根据标准化术前照片的回顾，设计了一种新的乳晕折叠形态分类。术后以 3 个月为间隔进行结果评估。
作者根据其临床外观确定了四种明确的乳晕折叠亚型，范围从不存在的 F0 型到形态良好且固定的 F3 型。检查的主要结果测量指标是术后是否存在双泡畸形。在我们的队列中发现了 3 例双泡畸形（<1%的患者）。所有双泡畸形均发生在 3 型折叠患者中。
乳晕折叠定义了乳房下极的下界，是美学乳房外科医生的关键标志。作者描述了一种独特而简单的乳晕折叠分类系统，该系统有助于选择适当的乳晕折叠入路，并辅助植入物尺寸规划。作者发现，该系统——特别是 F3 型乳晕折叠的识别——在 2000 多例病例中最大限度地降低了乳晕折叠相关并发症的风险。
临床问题/证据水平：治疗，IV。
