Raising a lowered breast fold?

Question

Had b/a 14 months ago. Had one breast fold lowered 1-2cm which has left my breasts uneven. My folds we even before! Can I raise the fold back to original position? How complicated isit to do? Along with a small areola lift and reduction? Thanks in advance

Thomas Fiala, MD, FACS, FRCSC · Answer

Yes, this can be done.  Internal sutures can be used to re-anchor the crease where it was previously.  It can be technically challenging to get it right, and sometimes, particularly in slender patients, the crease may not stay where it was put during surgery.  Sometimes, expensive ADM's are needed for reinforcement.  You may need to decrease the implant size, as well.  Your activities will also need to be limited for 2-3 months post-op.Best to see a plastic surgeon with significant experience in revisional breast implant surgery.

Adam Tattelbaum, MD · Answer

Thanks for your question. Raising of a fold is called Capsulorrhaphy. It is essentially a tightening if the scar tissue layer at the bottom of the breast.  While lowering a fold is easy because gravity works in our favor, raising a fold can be more challenging. The weight of the implant, especially if large, gravity and muscular forces, if you are submuscular, can tend to force the pocket open again. In some cases it is more predictable to temporarily remove the implant while the pocket heals. While most patients don't prefer this option it removes the weight of the implant and muscular forces as the lower pocket heals in.Your PS will have to guide you depending upon the size of your implant and muscularity.Hope this helps and best wishes.

Luis Villar, MD, FACS · Answer

Lower pole herniation has a number of causes and aggravating factors. Oversized implants under the muscle with an aggressive attempt to lower the infra-mammary crease at surgery in a patient that is athletic or pole dances, is a worst case scenario.  Analysis of the cause and aggravating factors is necessary to develop a plan of action that will minimize recurrence.  The use of grafts is not the first choice in our hands.  To see how to analyze and fix a worst case scenario see the attached video.

John Michael Thomassen, MD · Answer

This can be done with internal suturing and should leave no additional scars.  It does involve a trip back to the OR.  Reducing the volume and elevating the areola could also be performed at the same time.

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  It is possible raise a lowered fold, but it requires a surgical revision procedure.  Depending on your individual tissues sutures may be used to close the lower portion of the implant pocket or an internal scaffold can be placed to help reinforce the lower portion of your chest.  See an ASPS board certified plastic surgeon in consultation to discuss your desired correction.

Gerald L. Yospur, MD · Answer

The breast fold (inframammary fold) is a very important part of your breast that helps give it its form.  It is also a very important structure that helps keep the implant in the appropriate position and prevents it  falling downwards.  If this fold is interrupted then it can lead to what is called bottoming out of the breast implant.  It all depends on how much the fold has been disrupted.  It can  be repaired. It is not an overly complicated procedure but it does take time to heal so that a recurrence  does not develop.  This procedure could be combined with the procedures that you mentioned.

Erik Hoy, MD · Answer

Thanks for your question-- Your surgeon may have tried to lower the fold beneath the breasts purposely to accommodate the  implant, or this may have been inadvertent.  However, with this loss of support, implants are prone to descend further down the chest than they are supposed to.  To fix this, you would need sutures along the lower pole to reposition the implant.  Adding a mesh to the lower pole can reinforce the area and help prevent this from happening again.  Revision surgeries are more unpredictable than the initial augmentation, because of scar tissue and the altered blood supply to the area.  This is something that could typically be combined with a lift/reduction in the diameter of the areola at the same time.  You should discuss this with your plastic surgeon to determine your best options.

Tom J. Pousti, MD · Answer

I am sorry to hear about the problems you are having after breast augmentation surgery. Based on your description, I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair). This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Sometimes, depending mainly on the patient's history and physical examination, I will also use additional supportive materials such as acellular dermal matrix or biosynthetic mesh. Associated issues with positioning of nipple/areola complexes may improve with this operation. Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with revisionary breast surgery.

I hope this, and the attached link (dedicated to corrective surgery for bottoming out concerns), helps.

I hope this, and the attached link (dedicated to corrective surgery for bottoming out concerns), helps.

Raj S. Ambay, MD · Answer

The breast fold can be raised or lowered through surgery.  If a breast implant is in place, and it becomes exposed during surgery, then it will need to be replaced at the time of either lowering or raising the breast fold.  It is almost a sure thing that the breast implants will become exposed.  anytime and implant is exposed after its placement, the rate of infection goes up. Areola resizing or any kind of breast lift can be done at that same time.  Altering the breast fold and or revisions on previous breast work take more planning than doing the initial breast augmentation. My recommendation is that you visit with a board-certified plastic surgeon because the procedure can be complex.  Thanks again for your question!

Francis (Frank) William Rieger, MD (retired) · Answer

Thanks for the question, and this condition can occur for several reasons.  A proper examination and discussion with your Plastic Surgeon would be necessary to accurately describe what you specifically may need, but please be aware that tightening the capsule of the inframammary fold directly with internal sutures may be needed, possibly using an alloderm or  dermal graft substance that could be sutured to the internal support for your breast pocket may be needed, changing out the implant to a different implant that would be smaller may be needed, creating a new pocket that prevents the implant the opportunity to fall downward into the old pocket, raising the pocket by skin removal through  an inframammary incision,possibly advancing upward the skin below the breast to make the existing breast fold even,.... I am sure that you get the point that several options may be considered.  Choose your Plastic Surgeon wisely, be sure about the experience level of the Doctor, and actually you may start by discussing this with your current Plastic Surgeon to see what he or she wants to do in an effort to correct this problem.Good luck to you.Frank Rieger M.D.  Tampa Plastic Surgeon

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