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.

Doctor Answers 39

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

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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, but a physical examination is quite important in your specific case. It appears as if you have more skin laxity on one side, though this may simply be artifact because of your arm being elevated on the opposite side. Your present IMCs (inframammary creases) do not appear to be tightly adherent, and may well be amenable to being stretched by the (larger) implants you desire. Both standing and supine examination will help your chosen plastic surgeon decide what is possible, what is best, and what options exist to position your implants to yield the best aesthetic results.

In select cases, and you might just be one of them, lowering of the creases by the appropriate amount may in fact yield a better cosmetic result! There is always a (small) risk of "double bubble" when this is done, and not every case where this is more likely can be determined beforehand. I discuss this possibility with patients whose anatomy predispose them to this outcome, and we obviously do our best to avoid this whenever possible.

But simply saying "I never lower creases" is too simplistic, and an error in some patients where crease lowering is not only possible, but optimal! Better-looking results can be achieved by judicious choice to do this when needed, and yes, there may be an occasional double bubble outcome to correct.

However, I believe it is better to have to correct an occasional less-than-ideal outcome than to avoid doing the proper (better) surgical approach in those patients where the majority may have a superior outcome by doing so. Having the experience and wisdom to choose properly which patients this applies to is the key (not to mention having the humility to recognize that we will occasionally fail and have to make the necessary corrections).

The difference between great surgeons who try for superior outcomes (and occasionally fail) and everyday good surgeons who "always" choose the safe and formula approach is finding those who have the fewest re-dos. BTW, even those who choose the "standard and usual" still have failures and re-dos!

Just food for thought. See more than one ABPS-certified plastic surgeon and get a number of opinions. One will certainly resonate with you, and a consensus may even emerge as well! For several examples of "crease lowering" augmentations in my patients, click on the web reference link below and look at cases 2, 6, 14, 15, 16, 19, 22, 27, 30, 32, 35, 36, 47, 50, 57, 58, 60, 64, 70, 73, 75, and 81. As you can see from these numbers, creating a "new" crease is actually fairly common, and is based less on surgeon choice, and more on the pre-operative anatomy and goals of the patient, as well as having the surgical skill to achieve superior outcomes. Best wishes! Dr. Tholen

Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Lowering the Inframammary Fold in Breast Augmentation Surgery

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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).

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Lowering the Fold to Increase Implant Size

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   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

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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.

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon

Considerations for lowering the inframammary crease

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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 provide you with a recommendation. However, consideration can be given to a higher profile implant and ... one or more additional consultations with other board certified plastic surgeons.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 reviews

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

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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 augmentation as the implants settle. 

Altering the fold? choose the right size!

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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 because the height of the implant (which is the same as the width since it is round) would be too tall. For someone who has nursed 5 children your skin and breast tissue quality likely has lost a lot of the elasticity in once had. As a result it is difficult to maintain the implant pocket and not have the device trying to sneak out laterally. I understand your desire to regain your fullness that you had during nursing, but doing so at this point will require a heavy and wide implant that likely will result in implant malposition. I hope this helps. Best of Luck!

M. Scott Haydon, MD
Austin Plastic Surgeon
4.8 out of 5 stars 93 reviews

Lowering the fold in breast augmentation

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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.

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 62 reviews

Implant placement

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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.

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

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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.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

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.