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.

Dear Patient,
Generally, scars should be as close as possible to the fold, unless some type of breast lift procedure was performed.  Also, the fold could have been lowered during surgery to improve the overall esthetic look.

 

For our breast augmentation patients in Michigan, we often place the incision above the breast fold. This will allow you to wear a bikini, and if the bathing suit rides up your incisions will still be hidden.  Also, the incision is often underneath the natural curve of the underside of the breast that way as so less visible.

To have the incision an inch and a half is a bit high. It is common to have the incision at or just above the fold as this hides the incision well. If the implants are very large or the fold is "lowered" then the incision can rise up if the implants "bottom out." I recommend following up with your plastic surgeon for there are procedures which can correct bottoming out.

Hello. What you describe is not uncommon. It can be due to various factors, including the way the surgery was planned, the migration of the implant below the original incision line, stretching of the skin at the fold etc. If the scar is slightly above the fold, it will usually fade over time and not be very visible. If the scar rises well above the fold and is very obvious, this can be addressed by trying to reduce the color and thickness of the scar, using lasers or intense pulsed light, or by re-operating and moving the implants up, above the scar.

The best way I have found to avoid this problem is to suture the incision line to the deep tissues of the chest wall at the time of the augmentation, which greatly reduces the chance that the eventual scar will migrate. Since I began using this technique, I have not had any issues with scars above the fold.

Your situation is not uncommon, and unlikely a mistake. Depending on the size of your breasts, as well as the size of your implants, the crease below your breasts may have moved downward after the incision was made and the breast implants placed. While surgeons performing breast augmentation do their best to anticipate where the new fold will lie, the concern for making the incision too low is that it rests on your chest below your breast- this is an area where it can be more easily seen. Most surgeons, therefore, will err on the higher side, as a scar a bit above the crease is still hardly visible, and should become even less so with time. While the ideal and often attained position of the breast implant scar is right at the fold, migration of the scar a little higher, especially with large implants, can certainly happen.