Lower my inframammary fold or not? (photos)

Question

I have been to 4 board certified breast surgeons. 3 of which didn't mention lowering infra mammary fold or lifting nipple. The same 3 suggested 350-400 cc high profile implants. 4th doctor said without lowering my fold my lower pole would not accommodate 350 cc's. Actually he said lowering it wasn't an option.He is the youngest one with least experience-just a fact .other 3 surgeons measured my nipple to fold 7cm on stretch. He said that is an incorrect way of measuring. lower it or not????????

Donald R. Revis Jr, MD · Answer

Good evening!From your photos it indeed does appear that you will need your folds lowered, but this is just part of being a breast augmentation surgeon. The three who didn't mention it probably didn't think to mention it but all probably intend to do just that but just didn't speak it out loud.There is a big deal made online about lowering vs not lowering, and I get it- there are potential complications such as bottoming out, double bubble, etc., which are of course always a concern. However, if a fold needs to be lowered to fit an implant, then so be it that is what needs to be done. It's not a situation where you should be saying I am going to go to this PS over another because one mentioned lowering the fold and I don't want that. No one is going to lower your folds if you don't need it, but everyone will lower your folds if you do need it.I have attached a link to my Breast Augmentation photo gallery for your review- #105 looks just like you- hope it helps!

Hagen Schumacher, PhD, FRCS(Plast), FEBOPRAS · Answer

Hello,
Thank you for your enquiry. On the photos, your breast fold looks in a good position. Implants require a new breast fold because the diameter is larger than your natural breast. Breast fold surgery can also done on it's own without an implant but I don't think this is necessary in your case.

Michael Kreidstein, MD, FRCS(C) · Answer

Your areola/nipple appears to sit low on your breast, so I understand why you would think to either raise the nipple or lower the bottom of your breast to center your areola better.  Good news- you don't need to do it!  You can get a nice result with a straight forward breast augmentation.  Releasing the inframammary fold introduces a number of potential problems in breast augmentation (bottoming out, double bubble, etc), and you should not have this done without good cause.

Martin Jugenburg, MD · Answer

I think your question answers itself.Best thing to do is to be examined by a plastic surgeon with experience in breast augmentations.  More cases you do, more you become an expert.  Look at their before and after photos, see if you like what you see.  Look at their reviews.  Which surgeon do you trust?  Which office do you feel will look after you the best?  Remember that a surgeon is part of a team and his team is just as important.  Having a great surgeon but an office that doesn't care much about you is not productive.You do seem to have a very short nipple to fold distance.  If you do not lower your fold, there is a possibility that you nipple will be tethered to the lower part of the breast and you will end up with downward looking nipples.Nothing replaces an in-person assessment, however looking at your photos I would imagine your medial folds will need to be released to change your linear/slanted fold to a nice curve

Farah Naz Khan, MD · Answer

Your fold will have to be lowered slightly so your incision lies in your fold. Otherwise, your incision will be too high on the breast if your current fold is used. Often times, surgeons don't tell you every single step of the surgery. Best to choose the board certified plastic surgeon you feel most comfortable with to perform your surgery. Good luck!

Gary Lawton, MD, FACS · Answer

There is no need to specifically mention, it is just part of the procedure.  If you find the right surgeon they will give you the outcome based on the proper pocket dissection and implant placement.  There is no need for you to tell them what exact things need to be done, and there is no need for them to describe the exact technical moves that they will make.  look at their photos, describe what qualitative look you are trying to achieve, and pick the right surgeon.The fourth surgeon sounds like the worst of the recommendations. The recommendations are wrong, the lack of experience is a significant problem.  I typically don't stretch the fold to measure it, but the fourth surgeon is wrong about the volume as well.  This is a simple straight forward breast augmentation.

Robert S. Houser, DO · Answer

Nothing "fancy" needs to be done to your fold or nipple.  You have 2 different breasts, but adding the implants will change your breast shape quite a bit, so I'd advise again doing anything to the fold or nipple position.  Some very bad things can come from trying to change the fold position.  Good luck!

Steven Wallach, MD · Answer

It is in the rare case that the fold needs to be lowered. Lowering the fold comes with risks of bottoming out and poor expansion around the implant.

Ciro Adamo, PhD, MD · Answer

Looking at your pictures, it is very likely that you will need lowering of the fold. Actually so likely that I believe the surgeons you saw just assumed it as a given fact, but didn't go into details explaining what they were exactly going to do. I am pretty sure at least some of them would have clarified the issue when doing the preoperative marking, explaining where the incisions were going to be placed.Keep in mind that knowing the volume of the implants doesn't tell anything about the diameter, since different surgeons could use different profiles (moderate, full, extra full and so on). The higher the profile, the narrower the implant would be for the same volume, and with a narrower implant the need for lowering the fold decreases. There are many variables that may be too difficult for a patient to understand fully, and that's where you need to go with a surgeon you feel comfortable with and that can explain everything in a way that you understand easily. Not every patient needs the same amount of information, but it is wise to go with a surgeon that can answer all your questions.

Jeremy Pyle, MD · Answer

The position of the fold under the breast is one of the most important characteristics in choosing the size, volume, profile and type of implant.  The concept of lowering the fold is not a new one but it seems to be gaining a lot more interest in discussions now than it used to. The predicament you're talking about is a challening one because talking about lowering the fold is a lot easier than doing it well. Although age probably doesn't determine one's ability to do so, you wouldn't want to go to a surgeon who plans to lower the fold who doesn't have a lot of experience. It's worth noting that experience and skill aren't necessarily linked to age.  If you have been to four surgeon's it is clear that you are taking this process seriously and doing your homework. Ask the surgeon/s you like best how often they do this operation and, in the case of the fold lowering doctor, ask him how many times he has consciously lowered the fold. That doesn't have to be the only characteristic, but it will give you an idea of how comfortable he or she may be with your type of operation.Best,Dr. Pyle

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