How to fix a displaced fold (inferior fold displacement after breast reconstruction)?

This lovely lady had the unfortunate diagnosis of breast cancer found on her annual screening mammogram. ⁣
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She underwent bilateral nipple-sparing mastectomies through an inframammary approach. She then underwent bilateral immediate breast reconstruction with silicone implants and acellular dermal matrix. ⁣

Because of the elastic properties of the acellular dermal matrix (its ability to stretch over time just like skin), she suffered from an inferior displacement of her fold (descent of her native inframammary fold) resulting in device malposition. This descent of her right inframammary fold created an increased lower pole breast skin out of proportion to her upper pole. ⁣
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I always tell my patients that during the mastectomy, the primary role of the breast surgeon performing the mastectomy is to act as an oncologic surgeon and safely remove all of the breast tissue to increase disease-free survival. ⁣
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During the mastectomy, all the natural landmarks and ligaments of the breast are removed with the actual breast tissue and this includes obliteration of the inframammary folds as well as the medial and lateral borders of the breast. ⁣
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It is our job as plastic surgeons to reconstruct these with suture techniques and also with adjunct materials that inherently have properties to support the missing ligamentous structures. ⁣
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The soft tissues are variable in every patient according to their age, weight, and subcutaneous tissues as well as fascial tissues. ⁣
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She was brought back to surgery for revision and stabilization of the fold with GalaShape. Again, this material provides a scaffolding and support to counteract increased downward pressure from the implant in a patient with low body weight and minimal subcutaneous fat.⁣