Is It True That Lowering the Inframmary Fold Will Cause Bottoming Out?

A common
error that leads to an unnatural appearance after breast augmentation, even
with implants of an ideal size, is inadequate lower pole dissection and/or
inadequate release of the pectoralis major origin just above the inframammary
fold. As a result the implants sit too high and appear excessively full in the
upper poles (the area above the nipple-areola complex), while the lower poles -
which should be the fullest area of the breast - are underfilled. Inadequate
muscle release may also result in bizarre-appearing breast implant animation
when the pec major muscle contracts. In some cases this may result in one or
both of their implants jumping up literally to the level of a patient's
collarbones - an alarmingly unnatural look, and one that is totally avoidable 

  

A shaped form stable breast implant can give the patient
the lowest risk of fold and ripples in the lower pole, the lowest risk of a
visible transition between natural breast tissue and implant  (sometime
refereed to as a double bubble) and the lowest risk of breast implant
malposition with the breasts bottoming out.  I think there is a performance
difference between form stable breast implants. Consult with plastic surgeon
who have experience and expertise perfuming this particular procedure. 

 

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,
inadequate release of the inferior origin of the pectoralis major will allow
the muscle to hold the implant in too high a position, and may even cause the
implant to displace upwards (as high as the collar bone in some patients) when
the muscle contracts. Patients with this problem require reoperation to release
the inferior origin of the pec major and/or the inframammary fold.

Likewise, if the inframammary fold is lowered too far, the
augmented breast will appear 'bottomed out', with an excessively full lower
pole, an empty upper pole, and a nipple/areola that appears to sit too high on
the breast - another situation with a distinctly unnatural appearance, and one
that requires surgical correction: repair of the inframammary fold(s). 

There are instances where a lowering of the inframammary fold (IMF) is entirely appropriate and necessary - without photos there is no way to give you more specific information.  However, this needs to be done cautiously and carefully. Normally this would be discussed with you prior to your operation.  Discuss this with your doctor and perhaps you can get more information regarding your operation.

Fortunately, there are operations to correct this, but these are operations.  Deciding on how to proceed can be a challenge, but if you submit photos, perhaps you can get additional direction.

Best of luck

Vincent Marin, MD

San Diego Plastic Surgeon