Inframammary Fold Control in Tensioned Reverse Abdominoplasty: An Anatomical Reference for Integrated Breast and Abdominal Planning.

BACKGROUND: Tensioned Reverse Abdominoplasty (TRA) is used for the treatment of upper abdominal laxity. Because the technique directly involves the inframammary region, control of inframammary fold position should be considered during surgical planning, as inferior migration of the fold may alter thoracoabdominal proportions, modify breast morphology, and compromise outcome predictability. OBJECTIVE: To evaluate the influence of preoperative definition of inframammary fold position on surgical planning in TRA and on the need, indication, and extent of associated breast treatment. METHODS: This retrospective series included 50 consecutive patients who underwent TRA for aesthetic indications between 2019 and 2024. Preoperative assessment included clinical analysis of inframammary fold position, the relationship between the nipple-areola complex and the fold, and the effects of this relationship on breast morphology and thoracoabdominal proportions. RESULTS: A caudally displaced inframammary fold was identified in 19 patients (38%), exclusively among those with prior breast surgery. Thirty-nine patients (78%) had a history of previous breast surgery. An associated breast procedure was performed in 29 patients (58%). Among patients with a caudally displaced fold, 10 (52.6%) underwent breast-base mastopexy, 8 (42.1%) underwent full mastopexy, and 1 (5.3%) underwent unilateral breast-base mastopexy after declining the indicated bilateral correction. At 12 months, all patients maintained inframammary fold stability, with no secondary inferior migration. CONCLUSION: TRA provides predictable control of inframammary fold position, establishing an anatomical reference for integrated breast and abdominal planning. Preoperative definition of its position may modify breast assessment and guide the need and extent of associated treatment.