Breast Aug Scar is a Few Inches Above the Fold Line - is This a Mistake?

When planning the inframammary incision, it is important that your plastic surgeon takes several factors into the planning.  The scar will ascend from a few millimeters to a couple of centimeters after surgery.  The implant takes up some of the slack in the skin which pulls the upper abdomen up towards the breast.  The implant can lower the fold beneath the breast a little as well.

A well designed incision takes these factors into the equation to give the scar the best chance to end up in the fold.  Usually this involves making the incision a few mm below the current fold, not within the current fold.

It is not necessarily common to have a scar one and a half inches above the fold.  However, most incisions do not always end up right in the fold.  There usually is some migration of the scar above the fold even if the initial incision is placed below or in the original fold line.  Some of that migration is difficult to predict although the size of the implant does influence final scar location.  When an implant is placed in the breast, the previous amount of skin in the breast has to stretch to accommodate the new size.  As the new skin stretches, skin from the upper abdomen is pulled onto the breast as well.  This causes the scar to move up.  As you age with your implants, the breast skin can stretch some more and the implants can sag thus leading to further change in the scar.  As long as the scar is on the underside of the lower pole of the breast, it will not be visible.  Having the scar slightly above the fold (but on the underside of the breast) will actually allow you to wear smaller bathing suits without revealing your scar!

You want the incision on the breast.  An incision 1.5 inches above the fold is a little high, but a little high is better than a little low.  As long as the incision is on the breast it will be covered by most swimsuits or bras.  If it is too low then it could become more visible.

The incision is usually placed near your original fold -- and most folds are lowered as part of the surgery. (The larger your breast becomes the lower the fold has to go).  Each patient needs to be treated for their own specific needs and circumstances, and the incision in that area may have been the best position for you.

Your incision is too high (or your fold is too low) and your surgeon would probably agree.  Although this is not ideal, most breast incisions that are not in the crease end up being practically invisible in time.  If the scar is really in the wrong place, it can be revised but not really moved.  Probably best to leave it alone.

In my practice, this typically happens in women who start off with a fairly small cup size and add a large implant. A patient's chest wall is designed for only so large an implant, but most women I have encountered routinely go larger than their normal dimensions will allow.
When your surgeon marked you before your augmentation, he/she probably marked the incision right in your breast fold. If the implant was large, the pocket would descend below this margin causing the incision to visually rotate up onto the breast. As Dr. Rand has said, however, your implants may have descended too much and can cause the same basic visual problem.
I would ask you to speak to your surgeon about your concern and see what their analysis of your situation could be. Good luck.