@article{ABS9843,
author = {Axelle Stockmans and Maxim Geeroms},
title = {A planning algorithm for primary breast augmentation integrating inframammary fold morphology and chest-to-waist ratio to minimize the risk of lower pole deformities},
journal = {Annals of Breast Surgery},
volume = {10},
number = {0},
year = {2026},
keywords = {},
abstract = {Background: The aesthetic harmony of the breast is critically defined by its lower pole, with the inframammary fold (IMF) serving as a pivotal anatomical and visual landmark. Misjudgment of IMF position or strength can result in lower pole distortion, such as the double-bubble deformity and bottoming-out. Although several tissue-based algorithms have been published for breast augmentation planning, most omit an objective evaluation of the native IMF and its relationship with torso proportions. This study proposes a structured algorithm to guide implant selection and surgical planning.Methods: This retrospective cohort study included 126 consecutive primary breast augmentations planned using a structured algorithm integrating IMF morphology and chest-to-waist ratio. Preoperative planning included anthropometric assessment, standardized photography, and 3D simulation. All augmentations were performed through an IMF incision, using dual plane or subfascial technique, with round or teardrop implants of smooth, nanotextured or microtextured surfaces. Postoperative outcomes, particularly the incidence of lower pole deformities, were recorded.Results: IMF type distribution was as follows: F0 (2.0%), F1 (19.0%), F2 (52.0%), and F3 (27.0%). Round implants were used in 60.3% of cases and anatomical implants in 39.7%, with the majority having moderate plus/“demi” projection (69.0%). No cases of double-bubble deformity or bottoming-out were observed after a minimum follow-up of three months. One case of lower pole blow-out was detected at eight months postoperatively. One major complication (unilateral infection) and two minor complications (superficial wound dehiscence) were noted. Three patients requested elective implant upsizing. Mean follow-up was 8.6 months (range, 3–15 months).Conclusions: Our findings suggest that integrating IMF type and chest-to-waist proportion in surgical planning is associated with improved early to mid-term predictability and may reduce lower pole complications. Recognizing the IMF as a variable, patient-specific structure—and adjusting implant dimensions and IMF management accordingly—may significantly improve aesthetic outcomes and patient satisfaction in breast augmentation.},
issn = {2616-2776}, url = {https://abs.amegroups.org/article/view/9843}
}