Lower my inframammary fold or not? (photos)

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????????

Doctor Answers 16

Lowering the fold in breast augmentation

Dear Jennifer842010,

Thank you for your clinical post and photograph. From the photos presented both breasts have a fairly short nipple areolar complex inframammary fold distance and with a 350-400 cc or gram implant I too would agree that it is not an option that the IMF be lowered, but to provide the best aesthetic result and to minimize risk of a high riding implant and pseudoglandular ptosis, lowering the inframammary fold would be essential. In addition to lowering it it would also fix the inframammary fold to the chest wall to minimize long-term bottoming out of soft tissues by stable fixation techniques.

The thing with plastic surgery there is rarely one way to get a good result and many plastic surgeons would not lower the inframammary fold, however, I find the most stable long-term results and the best lower pole options especially when the IMF to inframammary fold distance is slightly short comes from lowering the inframammary fold by 1-1.5 cm with this size implant.

I think you need to continue to do the research that you’re doing, trust your instincts. A board certified plastic surgeon with experience is likely to get you an excellent outcome. Regardless, however, long-term stability and prominence of the upper pole may be problematic if the IMF is not lowered and if the new IMF is not affixed to the chest wall.

I know it can be confusing when you get different opinions from certified specialists, but plastic surgery, that kind especially, it is part art and science.

I hope this information has been of some assistance and best of luck.

For more information, please review the link below.

R. Stephen Mulholland, M.D.
Certified Plastic Surgeon
Yorkville, Toronto


Toronto Plastic Surgeon
4.6 out of 5 stars 82 reviews

Don't over-complicate it -- you just need an augmentation

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!

Robert S. Houser, DO
Columbus Plastic Surgeon
5.0 out of 5 stars 15 reviews

Risks of tampering with Inframmary Fold

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.

Michael Kreidstein, MD
Toronto Plastic Surgeon
4.7 out of 5 stars 29 reviews

Fold lowering?

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.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Lowering the submammary crease

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.

Ciro Adamo, PhD, MD
London Plastic Surgeon
5.0 out of 5 stars 17 reviews

Lower the fold

Whether or not to lower the memory fold is really predicated upon how much bigger the base wdith diameter of your breast implant is than the size of your original breast. You do want to measure the nipple to fold distance on stretch because that better replicates what's going to happen when you put the implant in. I find it easier in cases such as yours, to start the incision in the bottom of the areola in order to best lower the fold symmetrically on both sides. Plastic surgery is both an art and science. But like anything, the more you do a particular operation, the better you become. It's the Malcolm Gladwell 10,000 hour theory. Good luck with your anticipated surgery.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

Breast augmentation decision

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

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 425 reviews

Age and gray hair independent of skill and experience

As mentioned by others, age and years in practice, is independent of skill and surgical experience. I focus only on augmentations in a major metro and therefore consistently do 400-500 augmentations a year. That's more in a year than some surgeons will do in their career. Certain smaller markets cannot sustain plastic surgical subspecialists. In all aspects of medicine it is proven that lower complications, costs and length of hospital stay is strongly related to one variable -- Surgical volume. Whether it's cardiac bypass, hernia repair or joint replacement the data shows the more volume a surgeon does per year the better the outcomes. 

Select the surgeon that has an extensive before and after photo gallery that demonstrates reproducibly pleasing results among hundreds of patients with variable anatomy and desired look. Try not to worry about the technical aspects of the surgery as that's losing site of the only thing that matters....your result! Best of luck. 

Lower my inframammary fold or not?

Lowering the inframammary fold is commonly done during breast augmentation surgery.  Most often it is done on one side in an attempt to match  the areola to inframammary crease distance on both sides.  This technique does require experience because over aggressive lowering of the fold can result in bottoming out or a double bubble. Based on your photographs my guess is that the fold on the left side may need to be lowered but that on the right may not.

Please revisit the surgeon that she liked the best and who has the most experience and discuss this in detail.

Lowering the fold in breast augmentation

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

Jeremy Pyle, MD
Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 77 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.