OK to Get Breast Implants with Short Inframammary Fold?

I have BA in 2 weeks DR said my inframammary fold is 3cm & at risk for double bubble and might have to use small implants 250cc to avoid this, my question is will my implants be very high up on the chest or will they drop into place without lowering the fold and does a lower cc sound right?

Doctor Answers 10

Short Nipple to Fold Distance - Risks?

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There is always a risk that if you have a very short nipple to inframammary fold distance, that either the implants will sit high, ot that you will be at risk for a double-bubble deformity.  However, if done correctly, you can lower and secure the fold, release the old fold so that it stretches out with time, and still get the volume you desire.  This requires good planning and technique, and is something to really discuss with your surgeon before surgery.

Short lower pole and the Double Bubble

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Hi there-

Because the risk of a double bubble is caused by attempting to achieve more than is reasonable in a patient like yourself (by lowering the fold under the breast) with a short distance from the fold under the breast to the nipple, I do not believe in lowering the fold.

In fact, I NEVER DO IT.

I think the long term outcome in patients like yourself is much much better if, recognizing this, you start with a small implant- just what your current skin and breast tissue would allow without lowering your fold, and with a modified breast lift to elevate the nipple if necessary.

An "Around-the-Nipple" (Periareolar) Breast Augmentation MAY be a better Choice

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Every Breast Augmentation approach has benefits and trade-offs. While the breast fold incision has a few benefits, in my opinion, it has several more undesirable trade-offs of which you raised but a few.

The SIZE of the implant should be based on the amount of breast tissue available to cover it and give it a softer appearance, on the width of the flat part of your chest before it slopes sideways and on the stretchiness of your breast skin.

A periareolar approach allows more incremental adjustments in implant pocket size both inferiorly and to either side. This means a greater versatility and narrower asymmetry between breasts.

Discuss this with your surgeon and see if this is indeed what you want.

Peter A. Aldea, MD
Memphis Plastic Surgeon

Short inframammary fold

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I suspect that you mean the distance between your nipple and your inframammary fold is 3 cm. If so, that is extremely short. The volume is less the issue than the dimension (i.e. width and height and projection) of your implants. If you use a round implant, it's width should ideally fit within the width or vertical eight of your breast (in your case it is limited by the vertical height). We try to center the nipple on the implant meaning your implant needs to be 6 cm. wide. There are no round implant this small. You will need to lower your fold to some degree and/or switch to a shaped saline implant. Discuss this carefully with your surgeon.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

OK to Get Breast Implants with Short Inframammary Fold?

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I would proceed with your surgeon's advice. Double bubble, once it has occurred can be a difficult problem to repair. It is better to be preventing one than repairing one.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Short fold

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If you are very tight and have a short fold, you  may be better off with smaller implants and seeing how your body responds to this.  At a later time you may be able to go larger.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Lowering the inframammary fold for breast augmentation patients - View Photos

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A common error that leads to an unnatural appearance after breast augmentation, even with implants of an ideal size, is inadequate lower pole dissection and/or inadequate release of the pectoralis major origin just above the inframammary fold. As a result the implants sit too high and appear excessively full in the upper poles (the area above the nipple-areola complex), while the lower poles - which should be the fullest area of the breast - are underfilled. Inadequate muscle release may also result in bizarre-appearing breast implant animation when the pec major muscle contracts. In some cases this may result in one or both of their implants jumping up literally to the level of a patient's collarbones - an alarmingly unnatural look, and one that is totally avoidable 

A shaped form stable breast implant can give the patient the lowest risk of fold and ripples in the lower pole, the lowest risk of a visible transition between natural breast tissue and implant  (sometime refereed to as a double bubble) and the lowest risk of breast implant malposition with the breasts bottoming out.  I think there is a performance difference between form stable breast implants. Consult with plastic surgeon who have experience and expertise perfuming this particular procedure. 

In many breast  augmentation patients, the inframammary fold needs to be lowered in order to allow the implant to rest at a level that appears natural relative to the position of the nipple and areola. Ideally the implant should be centered directly behind the nipple-areola complex (NAC). In profile, the natural-appearing breast is not convex in the upper pole, and an excessively convex and overly full upper pole is a dead giveaway that a breast implant sits below the skin. In addition, inadequate release of the inferior origin of the pectoralis major will allow the muscle to hold the implant in too high a position, and may even cause the implant to displace upwards (as high as the collar bone in some patients) when the muscle contracts. Patients with this problem require reoperation to release the inferior origin of the pec major and/or the inframammary fold.

Likewise, if the inframammary fold is lowered too far, the augmented breast will appear 'bottomed out', with an excessively full lower pole, an empty upper pole, and a nipple/areola that appears to sit too high on the breast - another situation with a distinctly unnatural appearance, and one that requires surgical correction: repair of the inframammary fold(s). 

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Implants with short inframammary fold

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Yes, you are at a higher risk for "double bubble" effect. I recommend expander implants so during the post operative phase the implants can be expanded to effectively try and elinimate the folds.


Choosing your implant

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You are not alone.  As long as you and your surgeon have discussions about your expectations for surgery and the realistic results, you should do well.  Yes, your anatomy may affect the range of implant sizes that you can use.

Good luck.

Breast augmentation with a short IM crease to areolar border distance

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This is a not uncommon situation but one that does open up potential problems in BA surgery.  If you lower the crease too much, you may get a double bubble deformity.  If you go with too big an implant it will look very top heavy.  Don't place yourself in the hands of a rookie plastic surgeon for this kind of BA.

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.