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Is a Violation of the Inframammary Fold (IMF) Considered Malpractice?

asked 1 year ago by 6038anon in Myrtle Beach, SC
Latest answer by Robert L. Kraft, MD
Question viewed 1,216 times
Tags: breasts, female, saline implants, silicone implant, double bubble, folds, inframammary, replacement

In November 2009, I decided to replace 15 year old saline implants after being told by a cosmetic surgeon that they were deflating. The doctor convinced me that I would be much happier with the results of silicone implants. After 8 weeks, my implants bottomed out and I now have a double bubble. A consultation with another surgeon has suggested that the doctor attempted to lower my IMF. I have been left in pain and discomfort with breasts that feel like they are hanging off my body.

12 answers to Is a Violation of the Inframammary Fold (IMF) Considered Malpractice?

Infra-mammary crease scarring

Usually, the incision is made in the infra-mammary fold and, if you need to lower it to widen the base, the scar will rise up onto the bottom of the breast. If the tissues are released properly,you would not have a double bubble. "Bottoming out" is not a double bubble nor does it cause one. Without photographs, your condition cannot be evaluated but I wish you the best of luck in correcting it. As described, I would not consider the situation you describe as malpractice. more

Robert L. Kraft, MD
New York Plastic Surgeon

Bottoming out after a breast augmentation

Lowering of the fold to adjust for volume is not uncommon and is often done in the event that you require adjustment of shape or volume . It is done routinely with a tubular breast deformity. There are solutions to your resultant issue but pictures would help to define the exact solution(s). All the best, Talmage J. Raine MD FACS

Talmage J. Raine, MD
Chicago Plastic Surgeon

Violating The Breast Fold

Lowering the breast fold is sometimes performed and is certainly not malpractice. I suspect you have large subpectoral gel implants. Your problem can be corrected by possible implant exchange and capsulorraphy but without photos and an examination, I am only guessing. Was you "cosmetic surgeon" a board certified plastic surgeon and a member of ASPS?

Richard Linderman, MD
Indianapolis Plastic Surgeon

Lowering the fold in breast implant surgery

In general, I try to limit manipulating the IMF when possible to minimize this particular complication but it can be unavoidable as a required step. It's a well described manuever that's withing standard of care for breast surgery otherwise, so it is not a de facto instance of medical malpractice or negligence

Robert Oliver Jr., MD
Birmingham Plastic Surgeon

Double bubble

Many surgeons purposefully lower the fold so that they can match the folds better and sometiems treat tuberous deformities. Also implants can spontaneously fall below the fold in some patients.

Steven Wallach, MD
Manhattan Plastic Surgeon

Is a Violation of the Inframammary Fold (IMF) Considered Malpractice

No it is not. In fact in many conditions, such as tuberous or constricted breasts, this isconsidered an essential part of the operation.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

The Breast fold

Lowering the infra-mammary fold is part of the procedure with a breast augmentation. A breast augmentation lowers the fold. A breast lift or reduction raises the fold. This is normal and appropriate. It is possible the infra-mammary fold may be excessively lowered. Should that occur it may be corrected.

John M. Anastasatos, MD
Beverly Hills Plastic Surgeon

Inframammary Fold Disruption (Bottoming Out)

This unfortunately does happen with this surgery and is correctable. The fold is sometimes lowered to the desired position, but it does sometimes drop, either from too large of an implant for the body or inadvertently. This does not mean that there was malpractice. I would discuss the problem with your plastic surgeon and come to a resolution. Good luck.

Farbod Esmailian, MD
Orange County Plastic Surgeon

Malpractice

I am sorry that you did not have your desired outcome. The direct answer to your question from a medicolegal position that a bad outcome does not equal malpractice. Malpractice may have been committed, but then again, it may not have been. One thing for sure is that you shoule not still be in pain, and the bottoming out can be corrected. Hope this helps a ltiile anyway. sek

Scott E. Kasden, MD
Dallas Plastic Surgeon

Inframammary fold malposition

As you can see from the other answers, lowering the fold is sometimes necessary and sometimes happens even without the surgeon's intent. This is not malpractice. But do make sure that you are going to a real plastic surgeon, not a "cosmetic surgeon."

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Lowering the IMF during breast revision surgery

The infra-mammary fold is an important anatomic landmark of the breast. It marks the junction between the breast and chest wall. It can be intentionally lowered (or raised), and it can also be unintentionally disrupted. Every surgeon on this forum has likely unintentionally lowered an IMF while creating a pocket for a breast implant. I'm certain that you were informed of implant position, asymmetry of breasts, bottoming out and other problems associated with revisionary... more

Scott Sattler, MD
Bellevue Plastic Surgeon

The Inframammary Fold may NEED to be Lowered in Breast Augmentation Surgery

I really sympathize with you but must tell you that nothing saddens me more than surgeons who are only too glad to screw over a colleague or a patient whose first reflex reaction to a disappointing result is to assume that malpractice had been committed. Obviously, your result is not what you expected nor wanted. But I would assure you that the vast majority of Plastic surgeons agonize each time they encounter a complication. A complication is NOT a bad event that as doctor we see... more