The harmony of proportions Exploring the golden ratio concept in nipple-sparing mastectomy through inframammary fold incision

Background: The inframammary incision appears promising in nipple-areola-sparing mastectomies (NASM). The Golden Ratio principles may standardize the extension and position of this incision, placing it in the lateral 2/3 of the fold. The authors explored the inframammary approach within the Golden Ratio concepts, to standardize its usage. Methods: This prospective study enrolled breast cancer patients eligible for NASM and implant-based breast reconstruction, excluding those with medium-severe breast ptosis. Incision lied in fold’s lateral 2/3 with a 1.618 ratio. Patient demographics, tumor characteristics, surgical complications, and aesthetic outcomes were recorded, with a minimum follow-up of 6 months. Results: A total of 108 patients were enrolled between August 2019 and December 2023. The inframammary fold averaged 11.8cm, while the medium incision length was 7.3cm. During an average follow-up of 20 months (range 6–47), six cases (5.5%) showed early postoperative complications. Two cases of severe capsular contracture necessitated implant replacement, and 4.6% of patients (5) developed rippling. Locoregional recurrence occurred in one case (0.9%). Aesthetic satisfaction scores were high: breast shape average score was 4.3, breast volume was 4.23, inframammary fold position was 4.1, and scar position was 4.8. Conclusions: NASM coupled with implant-based breast reconstruction allows the surgeon to focus on oncological safety without compromising aesthetic outcomes. As in all surgical procedures, patient selection is paramount, as well as thorough preoperative planning. To give an answer to “when,” “where” and “how” performing an inframammary incision in NASMs, the authors used the Golden Ratio principle achieving natural-looking reconstruction and high levels of patient satisfaction.