Can Inframammary Fold Be Sutured to Fit Smaller Implant?

If my natural inframammary fold was lowered and the sides of my breasts where made wider to fit the diameter of my 500 gram implants, can they be sutured successfully to fit the smaller-diameter implant(425 grams), resulting in breast thats don´t look to wide and low? Is the result permanent? Meaning that the weight of the implant won´t make it big again? Thanks for all your valuable answers.

Doctor Answers 13

Inframammary fold suturing after breast augmentation is possible

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Reconstruction of the inframammary fold after it has been lowered or violated by breast augmentation surgery or "bottoming out" of a breast implant is possible.

I call the procedure an "Internal Ryan Procedure" named after Dr. Ryan who developed the technique for reconstruction of the inframammary fold during post mastectomy breast reconstruction. Some call the procedure a pexy.

The breast implants are removed and a permanet suture is used to suture the inferiorly displaced tissue to the rib cage along a predetermined line which marks the normal position of the inframammary fold.

In my experience, a good repair using permanet sutures results in a permanent correction.

Some people have skin which stretches easily and are predisposed to "bottoming out" of the impant. In these people, the inferior skin and breast tissue can stretch out again, and the implant can "bottom out" again. These people typically have very thin, fair skin.

Pocket revision is possible

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There are two ways to handle your problem. The first is to remove your implants and stitch down the pocket so that the smaller implant doesn't sit too low and lateral. The second way is to remove the implants, obliterate the extra pocket and go back in after 3 months of healing with the new implants.

Obviously the first is more attractive because it only involves one operation but depending on one's anatomy the second plan is sometimes advisable. Go to the very best plastic surgeon in your area because this is not as simple to get right as doing a regular augmentation.

Can inframammary fold be sutured up?

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Yes, it is possible to lift the fold. Not an easy procedure but it can certainly be done. It is called an internal pexy or capsulorhapy, either way it comes down to suturing the fold into a higher position. Look for someone who enjoys performing revisionary breast augmentation surgery and that surgeon should be able to give you an honest idea of your results. Good luck

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.9 out of 5 stars 93 reviews

Implants and capsulorrhaphy

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Suturing the pocket to make it a bit smaller to accommodate implant changes is performed all the time.  Yes, the implant can still drop or bottom out over time.  This is usually a bigger problem with the heavier larger implants

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

The heavier the breast implant, the bigger the problem

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A low inframammary crease can occur, especially with large implants. The crease can be raised, but it is technically challenging. A permanent suture can be placed into the covering over the underlying ribs to give added support.

The biggest problem is keeping the result from dropping down again over time. The heavier the implant, the bigger the problem.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Smaller implant can be accommodated

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Surgery to accommodate a smaller implant is certainly possible. It requires a technical challenge sometimes, so see a qualified plastic surgeon in your area. Good luck!

Revision surgery is possible.

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Revision surgery is possible. Internal sutures can be placed to modify the implant pocket to accommodate a smaller implant. Additionally, Alloderm or some other product can also be used to make an internal sling to help support the implant in its new position. Good luck with our surgery.

Suturing the inframammary fold is commonly done

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Sutring the inframammary fold and narrowing the implant cavity is possible, and is a common practice when patient go to a smaller implant. In extreme cases, we tend to use Alloderm to add more power to prevent displacement with the implant weight. Hope that helps.

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews

Inframammary Folds can be raised.

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The inframammary folds can be raised with permanent internal buried sutures.  The result is usually permanent.  Similarly, the implant pockets can be narrowed.

I place the patient in the sitting position during surgery to make sure the new level for the inframammary folds is correct.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

The inframammary fold can be recreated

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Plastic Surgeons are divided on the concept of the inframammary fold, some routinely destroy it to fit the implants, others (myself included) feel the fold is an important anatomical feature of the breast.

Destruction of the fold opens up a host of complications, probably the most well known is "bottoming out". This is caused by the unsupported implant heading south and stretching the areola to inframammary fold distance. Visually the breast has a large bulge in the lower pole and the nipples become "star gazers".

With properly sized implants, the fold should not need to be destroyed. The fold is difficult to reconstruct but I have to do about a dozen of them each year. Obviously you need to be cautious about your new implants.

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.