Lower pole to correct saggy breasts? (Photo)

At a consult I was told I would need silicone, over the muscle and lowering of the inframmorary fold which would basically create two creases below the breast. He did not have a picture to show me but explained it as I would have another fold underneath the fold. Also, I have different sized breasts and he said he would not use a different sized implant. Looking for some direction if you think his suggestions would give me the best outcome. Thx :)

Doctor Answers 10

Lower pole to correct saggy breasts?

Subtle lowering of the fold can be done without creating two folds but this requires precision in dissection.  Implant under the muscle is generally a better choice for most patients.

Kenneth Hughes, MD

Los Angeles, CA

Implants under the muscle

I cant think of a reason in the last 20 years that I thought it was better to place an implant above the muscle on a first time augmentation.  The risk for higher chance for capsular contracture is not worth the possible benefits.  But when one in 7 women also get breast cancer in orange county, I find it really hard to place the implant in the breast tissue, and make it slightly more difficult to get a mammogram that can rule out cancer.  Although the photographs are more difficult to see because of the angle, it looks like you could easily place the implants under the muscle and get a natural result.  Go see another board certified plastic surgeon, one that is a member of the American Society for Aesthetic Plastic Surgery for another consult and another opinion.  

Dan Mills, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 30 reviews

Lower pole to correct saggy breasts? (Photo)

I always recommend to have the implants placed under the muscle. Given the size of your breasts and the short distance between your crease and nipple, you should consider a relatively small implant to reduce the chance for a double bubble.

Ron Hazani, MD, FACS
Beverly Hills General Surgeon
4.9 out of 5 stars 255 reviews

Breast Augmentation to help lower pole and nipple-areolar position.

Hello Jean81-

With few exceptions, I believe that it is significantly better to place implants (gel or saline) under the pectoralis major muscle as this is associated with lower capsular contracture rates and more natural smooth transitions to the upper breast pole and cleavage. As there is essentially no muscle in the lower pole of the breast once the submuscular implant has been properly placed, the implant can fill out the lower breast pole equally well under or over the muscle. The lower curve of the implant should only be placed where it should be (not too low for the sake of the nipple) and then the nipple position adjusted. If a larger implant is used which would thus fill out the lower pole properly and give some fill in the upper breast, then maybe the nipple areolar position only needs to be lifted superiorly a small amount with a "crescent lift". In regards to any difference in breast volumes, this can be corrected with different size implants. 
Good luck to you. 

Mark Anton, MD, FACS
Newport Beach Plastic Surgeon
5.0 out of 5 stars 35 reviews

Double Bubble


If your doctor is planning on giving you a complication (double bubble), I think you should see some other doctors.  Additionally, there is no reason to place implants above your muscle.  If your anatomy warrants two different sized implants, than so be it.

An in person examination will allow a surgeon expert in cosmetic breast surgery to give you better advice. Certification by the ABPS and membership with ASAPS are important criteria.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 78 reviews

Lower pole to correct saggy breasts?

We frequently see patients with your anatomy anatomy, and I would have a totally different recommendation for you. In fact, I think the plan you mention has a high likelihood of a very bad result that can be difficult to correct. A surgeon familiar with dual plane implant positioning would find it easy to get nice results in your case with submuscular implants and dual plane positioning. Most surgeons would strongly recommend against destroying the natural fold.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

There seems to be some disconnect between you and your surgeon.

I'm not sure that you are understanding your surgeon correctly. While lowering your fold may be a good idea, no reputable surgeon would purposely create 2 creases below your breast. It is very difficult to tell from your photos and therefore make comment about your different sized breasts. Did you bring your concern about this to the attention of your surgeon? 
I would return to your surgeon for a 2nd consult to get your questions clarified. You can certainly also seek a second opinion with an in person consultation as well. Often times in the consultation, especially with breast augmentation, there is so much material that needs to be covered that it is easy from the surgeon side to miss telling you something. I would encourage you to make it your responsibility to ask the questions directly to your surgeon. 

Lily Lee, MD
Pasadena Plastic Surgeon
5.0 out of 5 stars 22 reviews

Increasing Lower pole to prevent sagginess (ptosis)

Thank you for your question and photos.
Based on this limited but helpful information:
1) lowering the fold (inframammary fold [IMF]) will cause the nipple areolar complex (NAC)to auto rotate to a higher position.
however the implant (breast mound)may sit lower than it should.
2) like building a house, the house (breast mound) should sit where it should. Then move the NAC to the correct position. 
If done the other away around the breast mound can sit lower thane it should and have a longer distance from your clavicle than it should resulting in loss of upper pole fullness and odd looking breast.

I suggest you contact a Bd. Cert. Plastic Surgeon with experience in both Breast aug. and Mastopexy.

my best wishes, 


Thanks for the photos and question.  It is difficult to give you an answer without an in person exam.  That being said, the plan does not seem to be the usual plan of attack and I suggest you visit with another board certified Plastic Surgeon for another opinion.  In my practice, I very rarely go above the muscle as I believe going behind the muscle has clear advantages.  Furthermore, lowering the crease can be challenging and can lead to deformities that are difficult to repair.  I hope that helps!

Jeffrey Umansky, MD
La Jolla Plastic Surgeon
5.0 out of 5 stars 35 reviews

Lower pole to correct saggy breasts?

The answer is the same as in your prior posted question.

Following the advice from a surgeon on this or any other website who proposes to tell you what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest. I would suggest that your plastic surgeon be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.If you are still concerned, get a second opinion.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews

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.