Inframammary Crease Positional Relationship to th

Authors: Nanigian Brad R Wong Granger B Khatri Vijay P

Publish Date: 2007/09/01

Volume: 27, Issue: 5, Pages: 509-512

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Abstract

Brad R Nanigian Granger B Wong Vijay P Khatri Inframammary Crease Positional Relationship to the Pectoralis Major Muscle Origin Aesthetic Surgery Journal Volume 27 Issue 5 September 2007 Pages 509–512 https//doiorg/101016/jasj200706002Methods The study included 20 female cadavers and 10 patients with breast cancer with planned mastectomies The course of the inframammary crease was tattooed to the underlying chest wall with marking needles and methylene blue dye Marking needles were placed along the fold at the midclavicular line 2 cm medial to the midclavicular line and 2 cm lateral to the midclavicular line After removal of overlying soft tissue measurements were made between the IMF markings and the inferior origin of the pectoralis major muscle Chest walls of the cadavers were examined bilaterallyResults The IMF was located inferior to the inferior origin of the pectoralis major muscle in all measurements of all specimens The average distance of the IMF below the pectoralis major origin in the cadaveric group at the medial midclavicular and lateral locations was 19 20 and 25 cm respectively The average distance of the IMF below the pectoralis major origin in the mastectomy patient group at the medial midclavicular and lateral locations was 15 16 and 22 cm respectivelyThe inframammary fold IMF is a visual marker of the breast and its importance for both aesthetic and reconstructive procedures is well accepted The IMF determines the inferior border of the breast on the chest wall and defines ptosis In addition it provides inferior support for subpectoral implants that is essential to prevent migrationPrevious investigations of the IMF have focused on histologic study Whereas some investigators have identified a welldefined ligament creating the fold others have found no distinct structure1–3 Proposed explanations for the IMF have included a condensation of the superficial fascial system as well as an increase in dermal collagen24 Clinically we have noticed a constant relationship between the IMF and the inferior origin of the pectoralis major muscle that coincides with the embryologic development of the chest wall5 The purpose of our study is to identify a relationship between the inferior origin of the pectoralis major muscle and the inframammary foldTwenty female cadavers were examined Ages ranged from 74 to 95 years Inclusion criteria included surgically unaltered chest walls Both sides of the chest were examined The cutaneous inframammary fold was identified and then marked into the underlying chest wall with a 25gauge needle dipped in methylene blue at three points along the fold the midclavicular line a parallel line 2 cm medial to the midclavicular line and a parallel line 2 cm lateral to the midclavicular line Figure 1 The skin and subcutaneous tissue were removed exposing the chest wall musculature and the blue markings Figure 2 The distances between the inferior origin of the pectoralis major muscle and the blue markings were measured by millimeter caliper Table A positive value was recorded if the pectoralis major origin was above the IMF A negative value was recorded if the pectoralis major origin was above the IMF

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