Why and how do surgeons create new inframammary folds in the breast?

how does a surgeon decide if he needs to create this new fold? is it because the breast sit too low on the chest? how do they create the new fold?

Doctor Answers 6

'Creating' a new fold under the breast

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will vary from when the implant exceeds the patient's natural base width to elevating an implant and reconstructing the fold at a higher point.  But its done routinely, depending on what the problem is.

Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Breast fold

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Hello again Mariie,
    It is not necessary in every breasts augmentation surgery to create a new infra mammary fold. If the distance between the IMF and the nipple is 7 - 9 cm, there is no need for new fold because there is enough room even for  large implants. When  the distance is short , it is necessary to lower crease ( IMF ) to create room for the implants and in case of mild ptosis ( saggyness ) , give a lift to the nipples. It is easier and more natural to create the new IMF through a subareola incision that allows better visualization and control of the area.  Always, consult with experienced board certified plastic surgeons. Check their before and after pictures to make sure that they are numerous, consistent and you like the results.
                  Best of luck,
                                         Dr Widder

Internal Ryan procedure is used to create an inframammary breast fold

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Most plastic surgeons are very careful not to violate or damage the inframammary fold when doing breast augmentation.

When an implant has bottomed out or in cases of breast reconstruction after mastectomy the most common procedure to create an inframammary fold is called the internal Ryan procedure.  During this procedure the surgeon uses sutures to stitch the breast fold to the periosteum of the rib to establish a new crease beneath the breast.  In cases where a breast implant capsule is present the capsular tissue can be pexied or tightened any new fold created from inside.

Inframammary fold manipulation and augmentation

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I do not usually undermine the breast fold to place breast implants, but on occasion especially with a constricted lower pole, I am forced to do so.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast augmentation and the inframammary fold

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You need to be careful about manipulating this structure.  Skin quality, breast tissue, skin laxity, and the implant size will all play a role in maintaining the position of this structure in augmentation.

In breast augmentation I have chosen to spend time reviewing photographs with patients to fully understand their expectation of size and shape. Many times this simply raises more questions. I will make measurements and use the implant guides to allow the patient to understand exactly the sizes that are reasonable for their body type and measurements.

Please find an experienced Board Certified Plastic Surgeon and member of the Aesthetic Society using the Smart Beauty Guide. These Plastic Surgeons can guide you on all aspects of facial surgery, breast augmentation and body procedures including tummy tucks or mommy makeovers!


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A loaded question but basically the size of an implant will dictate how far the nipple should ideally be from the fold and if it is not that distance an incision lower down on the chest would likely be used to accomodate for the size of the implants

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.