Breast Augmentation: Q&A

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How Often Do PS's Lower the Natural Crease of a Woman's Breast?

My board certified surgeon said, because I have high breast mounds she needs to do this. I do have 6-7cm from my nipple to my crease.

I nursed my all FIVE of my children. I went up to a 34D while nursing. My structure is: shoulders same width as hips. Proportioned that way. Waist measures 26 and hips 35-36.

I have ribs that are wide set and the protrude as well. I am 5ft 6.5in and weigh always between 134-138lbs. I am athletic and muscular. My band measures 31in and I wear a A34 bra. My implants will be 475cc mod+ mentor silicone. Possibly 450 or 425 if the sizers during surgery won't allow.

Thanks for your input! I am wanting to achieve a conservative D cup.

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38 Doctor Answers | Asked by Limaboro in BC

Doctor Answers (38)
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Lower the Natural Crease of a Woman's Breast?

Given your photos, which show a normally positioned breast fold, and your history of having been a D cup with nursing, I would recommend not messing with the fold. The fold can be lowered when it is abnormally positioned, and in that setting the benefits often outweigh the risks. With a normally positioned fold in a patient who has already been the size that is the current goal, I see only risks, and no benefit. Thank you for your question and for the posted photos.... more

Altering the fold? choose the right size!

You don't need an aggressive lowering of your fold. You need a smaller implant. Looking at your pictures and your height/weight, I can't imagine that your base width diameter would support such a wide implant. Implants are like shoes. If you wear a size 6 shoe, you can cheat 1/2 sizes but you can't wear a 4 or an 8. Implants are similar in that they have a unique base diameter based on the profile that allows you to choose the appropriate size. The rational for lowering the fold was probably... more

Lowering the breast fold

I think that the natural breast fold is one of the most important landmarks of the chest wall and that it should be respected during breast surgery. Once the fold has been violated, it is often difficult to effectively re-establish. I think that your implant size choice is too aggressive and it would be better to choose a smaller sized implant which would necessitate less interference with the IMF.

Lowering the Inframammary Fold in Breast Augmentation Surgery

In many breast augmentation patients, the inframammary fold needs to be lowered in order to allow the implant to rest at a level that appears natural relative to the position of the nipple and areola. Ideally the implant should be centered directly behind the nipple-areola complex (NAC). In profile, the natural-appearing breast is not convex in the upper pole, and an excessively convex and overly full upper pole is a dead giveaway that a breast implant sits below the skin. In addition,... more

Michael Law, MD

17 reviews

Raleigh-Durham Plastic Surgeon

michaellawmd.com

Inframammary line movement is minimal

The inframammary fold is an important landmark, and is usually not substantially changed with an augmentation. It may be elevated somewhat by the lower pole of the implant.

Lowering the Fold to Increase Implant Size

Lowering the fold to increase implant size can be done from a technical standpoint. Lowering the fold is frequently necessary in constricted or tuberous breasts. However, based upon your photos, you should get a nice result without lowering it.

Infra mammary fold

I rarely lower an inframammary fold and I dont think this is a good idea if the objective is to fit larger implants.. They are sometimes asymmetric but this difference is minimal, maybe at most 1/2 cm. If the fold is adressed the higher one is freed by the difference so the implants and nipple areola complexes are lined up. You do not need to have your fold lowered.

Considerations for lowering the inframammary crease

The questions should not be how frequently does one lower the fold but, instead, would it be appropriate for you. The fold is an important anatomical landmark or a variety of reasons and its disruption/violation can be associated with untoward consequences. As a result,, it should judiciously be changed only in such circumstances as different fold heights between the two breasts or for constricted breasts. Without a full examination and consultation of you, it is impossible to accurately... more

Lowering the crease of a woman's breast is seldom necessary

Although lowering the crease of the breast during a breast augmentation is possible, it is rarely indicated and can lead to problems in the near future. You should choose an implant whose diameter fits well within your breast width. If a larger implant is desired you might opt for a higher projection. From your pictures, I do not think that lowering your IMF (breast crease) is necessary. Your measurement from the nipple to the crease of 6-7 cm is normal and will likely increase with breast... more

"Never" and "Always" are terms that are rarely applicable in plastic surgery. Lowering breast folds is possible.

This question has obviously stimulated lots of discussion, given the number of my colleagues answering. The majority favor NOT lowering creases, usually because this "violation" has the potential for creating less aesthetic results in some patients. Basically, I agree, although every patient's anatomy is different, as are their goals regarding final breast size and what breast volume and skin elasticity they "bring to the party!" Thanks for including photographs; they are quite helpful,... more

Lowering the fold in breast augmentation

I agree with the theme that lowering the fold can result in a poor outcome. In your case based on the photos "a reasonable" implant size in silicone moderate plus profile would be 375 to 425 range. Bigger implants on your frame will likely overload the soft tissue envelope and not be a stable, attractive long term result. Good luck and consider a second opinion from a board certified plastic surgeon.

Implant placement

I think it would be a huge mistake to lower your fold. One can release the muscle w/o lowering the fold, and this will allow more stretching, and a natural result w/o lowering the fold. I try to never lower the fold as it can cause real aesthetic problems.

Should I have my Breast Fold lowered?

I agree, I rarely lower the breast fold, it is very difficult to lower a fold exactly and have it fixate in the proper position. Based on your pictures I would be hesitant to lower your fold but would instead opt to fill your breasts evenly. Good luck and if uncomfortable seek a second opinion.

How Often Do PS's Lower the Natural Crease of a Woman's Breast?

In my practice I have rarely found lowering the crease to be necessary. Based on your photos and measurements I do not think it wouod be a necessary maneuver. Maybe you should get more than one consult.

Will I need to have my inferior fold lowered in having a breast augmentation.?

Lowering the crease of the breast is usually done when the distance from the bottom of the areola to the fold is less than 6cm., or is very constricted. Your breasts need to be increased in size with adequate implants, but the skin looseness should allow a fuller implant to be placed. I am unsure as to how many cc.'s this may equate to without measuring the width of your breast Your Plastic Surgeon possibly is correct, but without examining you I would be unable to answer this... more

How Often Do PS's Lower the Natural Crease of a Woman's Breast?

I agree with my colleagues that the inframammary fold is to be treated with respect. It should be lowered rarely and only when necessary. However, if your surgeon plans an inframammary approach, and based on the implant you describe, your incision would need to be placed 9 to 9.5cm below your nipple. This automatically means that your fold would be lowered. Good luck!

Lowering the Breast Fold

A breast fold is most often lowered if there is a significant difference between sides to make them more even, if you have constricted or tuberous breasts, or when placing large breast implants that can't be accommodated by your current breast dimensions. Lowering the breast folds do not seem necessary when looking at your photos. And, based on the size of the implants you're considering, lowering them during surgery may risk the implant "bottoming out". This happens... more

Lowering inferior breast crease

The lower fold of the breast is where the ligaments (Cooper's Ligaments) that support the breast gland orginate, and therefore I believe that manipulating the inframammary crease is something to avoid. The ligaments form a "net" that not only supports the breast gland but would also support the weight of the implant as well. When the crease is changed that means that the ligaments are altered as well, which I believe can result in malposition of the implant over time. If the crease must be... more

Try Not to Fool with the FOLD.

Thank you for the pictures. Every surgeon is different as well as every situation is different. I try not to lower the fold. What plastic surgeons typically try to due is to increase the distance between the fold and the nipple by releasing the muscle above the natural to allow room to place the implant. Dr. ES

Is the Natural Crease Below a Woman's Breast Frequently Lowered?

And the answer is...............it depends. Some women have breasts in which the lower portion is underdeveloped or not very full. In some, the crease is relatively high and the distance from the lower border of the areola to the chest wall is short (less than five centimeters). In this situation it is sometimes necessary to lower the fold to some degree so that when your implant finally settles it is centered behind your nipple position. It the fold is left too high then your nipple will be... more

How Often Do PS's Lower the Natural Crease of a Woman's Breast?

I do not ever lower the inframammary fold and I think most plastic surgeons do not lower it as well. There may be a need for it with a short nipple/areolar to IMF distance but that is not the routine case.

Lowering the fold in a breast augmentation

Thank you for the pictures and measurements that you provided. In your case it doesn't seem from this online limited evaluation that you need any significant manipulation of the fold. In general the manipilation of the fold is done when the lower part of the breast is too constricted and the fold rides higher. Changing the fold is also done when there is a difference between the two sides. The implant has to be centered below the nipple/breast mound, and that's why the correct size implant... more

How Often Do PS's Lower the Natural Crease of a Woman's Breast

Very often, and the size that you are talking is a big size, it needs a very big subcutaneous dissection.

Lowering the breast fold can cause problems

Thanks for your question. I do not lower the breast fold with breast augmentation surgery. The breast fold is sacred territory. Once it is disturbed it is very difficult to recreate it. And disruption of the breast fold can lead to a double bubble deformity. You should find out why this was recommended and see if something else can be done to avoid that.

Lowering the breast crease how often

Thanks for the question. women with small "A"cup with little sagging and if they are looking for large B or C cup will only get enough space when the crease is lowered and I end up doing this surgery in almost 30 % of my patients. These are generally single women looking for getting married. This is right that 7 cm distance to nipple is normal but from your pictures it seems you have long barrel shaped chest and if the crease is not lowered you might end up with a mount on the flat part... more

Lowering of IMF with Breast Augmentation

Dear Limaboro, There are some conditions that require lowering of the infra-mammary fold of the breast, however it is not typically performed in routine breast augmentation. Judging by your photos, you appear to have physical attributes that would make your procedure relatively straight forward (routine if you will), such that you would not need lowering of your IMF. Best of luck to you!

IMF adjustment

Based on photographs, I do not think that the fold should be intentionally lowered more than the normal adjustment down of 1 cm or so that occurs with breast implants. Ask your surgeon if that is what they were referring to.

Breast crease does not appear to need lowering

From the pictures you submitted, I agree with many of the others that your breast crease does not look like it would needs to be lowered to acheive a good result. As you can tell form the answers, however, each surgeon has a slightly different approach to this surgery and none of them are absolutely "correct". I do not lower the crease very often, but that does not make me any more correct than those that find it necessary. My best advice is to discuss your... more

Breast Augmentation and Lowering the Inframammary Fold

Lowering the breast fold during breast augmentation is generally reserved only for those women with a deficient nipple/fold distance, and when the size of the implant is such that lowering the fold is required so the implant is not riding too high. You appear borderline for needing your fold lowered, but this assessment is best made in-person.

Lowering the inframammary fold

Although it is not the typical goal to lower the inframammary fold when putting breast implants in, I believe it is almost universally the side effect of the operation. If you use a very large implant and/or go too low you can end up with complications. However, I do believe that lowering of the inframammary fold is nearly universal and your plastic surgeon is astute enough to have realized that and explained that to you.

Only implants

Looks like you have some breast asymmetry -- all you need are implants. I would expect some minor asymmetry post op -- but you will look a lot better with the implants only. I would not lower your IM line.

Lowering the breast crease

People do measurements on what are the "normal" or "average" lengths of various body parts. The "normal" distance from the nipple to the fold under the breast should be about seven centimeters. Judging by your pictures, I would say that you have a normal shape to your breasts. You have lost some volume in your breasts but you are not sagging. The simple addition of a breast implant should restore your lost volume. In my opinion, you do NOT need a breast lift and you... more

Lowering The Inframammary Fold

Thank you for the question and the pictures. From the pictures and measurements provided, it would appear as though you would not need your breast fold lowered. Lowering the breast fold is typically reserved for patients with deficient length as measured from the bottom of the nipple to the fold. Lowering the breast fold can lead to implant malposition, double bubble deformity, and breast asymmetry. While an on-line evaluation is never as accurate as in-person, I would suggest that you... more

Breast Augmentation and Breast crease

This is usually only done for patients that have very mild sagging. Be sure to consult with a Board Certified Plastic Surgeon to discuss your expectations and concerns.

Robert E. Zaworski, MD

4 reviews

Atlanta Plastic Surgeon

Breast Augmentation and the Inframammary Folds?

Thank you for the question and pictures. You will find, that there are no statistics that report how often plastic surgeons “lower the natural crease of the breasts" when performing breast augmentation surgery. This is because every plastic surgeon performs surgery differently and every patient presents with a different body type and different goals. Although I cannot provide you with precise advice online, some observations may be helpful to you. Firstly, you should be... more

I lower the breast fold to get a more natural- looking breast

To look natural, the breast must look balanced. If a woman has a small breast, there is a little bit of breast tissue below the areola and a little bit above. If you put in a large implant without lowering the fold a little, you will have an unnatural balance of breast tissue above the areola.

Lowering the breast fold

I usually do not lower the folds because it can lead to a double bubble or implant malposition. Some surgeons do this for patients that have mild sagging.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Lowering the breast crease is a very frequent maneuver

In the majority of breast augmentation procedures, the crease below the breast is lowered. It is important that your implant be placed in a position that augments the entire breast, and leaves the nipple in a central, natural position. While breast lifting can be an important part of shaping your new breast form, implant placement is also critical. If the crease of the breast is not lowered, the implant will protrude too high, and give you an operated, un-natural appearance... more