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.
Is a Violation of the Inframammary Fold (IMF) Considered Malpractice?
Doctor Answers (13)
Breast Implant Position and the Double Bubble
When an implant falls beneath the natural breast crease, two curves on the lower breast may be seen. The top curve is usually the bottom of the natural breast tissue. The lower curve is the bottom of the implant. This usually occurs in low breasts, or breasts with strong breast creases which have not been released. It is likely that a revisional procedure may be useful. Options include capsulorrhapy (re-creation of a crease with sutures), or fat grafting (injecting fat into the depression between the two curves). It will be important to consult with your board-certified plastic surgeon to see what options are best for you. Best wishes!
Infra-mammary crease scarring
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
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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?
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
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.
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.
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.
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.
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.