Percutaneous approach for inframammary fold creation combined with exclusive adipose tissue transfer in post-mastectomy breast reconstruction.

Introduction: The inframammary fold has an important role in breast's aesthetic and maintain and should be restored during breast reconstruction after mastectomy. Several techniques have been described, mainly based on an open approach, not adapted in case of complete reconstruction by fat grafting. To address these concerns, the authors propose a percutaneous approach for inframammary fold reconstruction.

Methods: This single-center, retrospective cohort study included female patients≥18 years old with a history of unilateral or bilateral mastectomy and deferred breast reconstruction using fat grafting with percutaneous inframammary fold creation. Patient data (age, BMI, prior radiotherapy, procedure details, complications) were collected. The percutaneous inframammary fold fixation combines a superficial liposuction of the lower thoracoabdominal area with a percutaneous overlock suture anchoring the dermis to the deep thoracic fascia, and a net suture in segment 4. This technique allows for moderate skin recruitment, simultaneous fat transfers in the same operation, and increase inframammary fold definition and breast ptosis.

Results: A total of 26 patients (29 breast reconstructions) were included. The median age was 59 years, and patients underwent a median of 4 interventions with a total fat transfer volume of 1190mL. Six patients required IMF revisions, with no major complications observed. The technique showed favorable outcomes with stable IMF definition over time.

Conclusion: This percutaneous inframammary fold creation technique, combined with fat grafting, broadens reconstructive options for mastectomy patients. It is safe, reproducible, and enhances breast aesthetics with minimal morbidity.