IMF Approach

Female To Male (FTM) & Female To Nonbinary (FTN) Reconstruction Chest Surgery

The IMF approach stands for the inframammary approach, which involves a horizontal scar located at the inferior chest wall which is like the scar in a Double Incision but does not allow as much customizability in terms of scar shape. This approach avoids the need for free nipple grafting and is possible in patients with no nipple ptosis and only a small amount of skin excess located at the inferior chest.

How the Procedure is Performed

First, elliptical skin excision pattern is developed similar to the Double Incision technique, with the lower skin incision located at the inferior chest fold. There is less customizability regarding scar shape after surgery and overall much less skin is removed compared to the Double Incision. Breast tissue is then removed through the horizontal incisions starting inferior and moving superiorly, leaving the nipple areola completely attached to the surrounding skin while developing a uniform skin flap. Following tissue removal, the skin incisions are closed together and the nipple remains attached.

Indications for the IMF Approach

No nipple ptosis (the preoperative nipple location is close to the ideal post operative nipple location)
Small amount of skin excess located at the inferior chest wall only

Downsides to the IMF Approach

The major downside to this approach is the lack of ability to relocate the nipple areola complex and the downward repositioning of the nipple areola that will result after skin excision, meaning that the nipple will be located slightly lower on the chest wall compared to your preoperative nipple location. The amount of downward repositioning is estimated based on the amount of required skin excision, which is a reason this procedure is only appropriate for patients with a small amount of skin excess located at the inferior chest wall. In addition, this procedure results in a scar that is similar to that of the Double Incision, without the benefits of relocating the nipple. For these reasons, this procedure is not commonly chosen my most individuals. The procedure does allow for a completely flat chest, but has a high likelihood of nipple numbness after surgery with loss of erotic nipple sensation.

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