Will my lower pole need to be lowered for breast augmentation?

You should have an excellent result with a breast augmentation. The crease would be lowered, but the implant itself will also do some of the stretching over time.

The most sophisticated approach to breast augmentation is through the armpit with a surgical camera (transaxillary endoscopic). Using this modern approach the space can be crafted under direct vision, with virtually no bleeding and no postoperative bruising. Most importantly, the shape of the breast is meticulously created. The other, older methods of insertion are technologically less advanced. Both silicone and saline implants can be placed through the armpit by a surgeon with skill and experience using this approach. The incision in the crease is the oldest method of placing the implants and puts a scar directly on the breast.

A round implant would be a better choice because they move more like breasts. The anatomic implants have a textured surface which makes them feel very unnatural. In addition, there is no benefit to anatomical. There is an X-Ray study that shows the implants from the side at 6 months. Standing, the round and the antomical implants have the same profile. When you lie down however, the anatomical implants do not change, which is unnatural. A round implant will change when you lie down, like a natural breast would.

HP implants, which are a more modern shape than moderate profile implants, fit most women better. They have a more appropriate base diameter and can be made to look very natural or very augmented, depending on where in the range the implants are filled to achieve a particular volume. High profile implants are the first choice in my opinion. I rarely find an indication to use moderate or moderate plus implants. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of volume, and where in the range the implant is filled.

There are many advantages to sub muscular dual plane placement and very many disadvantages to sub glandular placement. I would see no indication to do anything but sub muscular dual plane. Subglandular silicone implant placement is the historical approach to this surgery, and was widely used in the 1960's. The implant edges are more visible, the risk of rippling is higher, the implant is in contact with the non-sterile breast tissue so the risk of infection and capsular contracture is higher. The interface between the breast tissue and the muscle is blurred so the implant interferes with mammography more than sub muscular placement. The blood supply surrounding the implant is worse so the risk of capsular contracture is higher. The support for the implant is less so there is more long term shape abnormalities and sagging. The look of a sub glandular implant is much less appealing than a sub muscular implant. The placement of sub glandular implants makes any subsequent revision surgeries more complicated and less successful. There are no advantages to sub glandular implant placement.

The choice between saline and silicone is one that requires a complex discussion of all of the advantages and disadvantages of both implants. The issues to be considered are safety, density, mobility, rippling, rupture rate, consequences of rupture, detection of rupture, need for follow-up care, cost of follow-up, appearance, feel, sensation of heaviness, radio-density, mammograms, and costs, among other things. There are advantages and disadvantages of both products. The decision will ultimately be up to you based on what is appropriate for your particular situation. Beautiful results can be obtained with either implant.

The best way to determine the size that fits your personal perception of the perfect breast is to try on sizers. This way you can see how they fit on you, how they add to your current volume, and whether they fit your frame. Although the surgeon can guide you, only you will be able to tell what is the right size. Try on sizers. Measuring a diameter and then telling the patient what volume they can have (in high, moderate or moderate plus implants) in my mind is backwards. The patients should be allowed to choose the volume. Then the surgeon carefully considers the base diameter, projection, profile, manufacturer, and fill material that will achieve the patients goals of size as well as qualitative look (natural, intermediate, or bold upper pole fullness or projection), all the while taking into consideration the patient's anatomic features that will affect the outcome. The experience of the surgeon and the degree to which they explain the options to you is of utmost importance. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of implant. Don't let the doctor tell you what would look good on you. They cannot tell what you perceive to be the best size. There is no maximum. That is up to you.

Far more important than the technique is the skill and experience of your plastic surgeon. Choose your surgeon rather than the technique and let them explain why one technique may be better than another.  See the below link on some suggestions on finding the most qualified Plastic Surgeon for a Breast Augmentation.  Always insist on a board certified plastic surgeon.

Thank you for the question and the pictures. First let me say that from the looks of your picture, I would have to disagree with you saying that you have a tuberous breast. Please see the link I provided for an example of a true tuberous breast. Of course you should seek a in-person consultation with a qualified plastic surgeon to discuss the options available to you, but based on what I see, I think you would be a good candidate for a straight-forward breast augmentation. Now depending on the implant size you want and the desired outcome, your fold may need to be lowered to make room for the implant, but this can be discussed with your surgeon after you have decided on what type and size of implant you want, because this decision will be based on that information when compared to the measurements for your individual body. Best of luck to you!

It is very important to release the bottom of a tubular breast during a primary breast augmentation. I release the pectoralis muscle fascia in a radial fashion -up and down to help round out the originally flattened lower pole of the tubular breast. Several weeks of post-operative management with an upper pole band useful to maintain this new shape permanently.

Your photos do not show that you have tuberous breasts. Your lower fold appears to be fairly normal, just based on your photos. During your consultation, I would suggest asking your specific questions.

Based on your photos, you do not have tuberous breasts.  Lowering the fold is most likely unnecessary given your current photos.  Whether you need the fold lowered depends on the size of the implant and how much skin you already have in your lower pole of the breast.  You should have a beautiful result. 

First of all, you do not have the tuberous breast deformity. Secondly, lowering the crease in someone with the amount of breast tissue you have has a high likelihood of a double bubble deformity. I see this problem frequently when patients come in having previously had the crease lowered. A skilled surgeon using a dual plane augmentation can give you the look you like without that risk.