Is It True That Lowering the Inframmary Fold Will Cause Bottoming Out?

Your surgeon may have had good reason(s) to lower the inframammary fold.  Lowering the fold, in and of itself, does not cause "bottoming out."  A combination of skin and soft tissue elasticity, patient activity post operatively, tobacco use (retards healing and collagen formation), genetically determined healing characteristics, size and weight of the implant, as well as surgical technique and pre-surgical patient anatomy all influence the position of the inframammary fold after breast augmentation.

At the end of your healing process, a perfect result is partly characterized by a nipple at the very forward most projecting point of the breast, which should be in the very center of the breast mound.  If you had a low nipple areola complex pre operatively, but didn't get large enough implants to sufficiently lift the nipple to the breast center, your surgeon had a choice of adding scars (breast lift) or lowering the crease so the center of the implant (and your breast) drop slightly so it is directly behind the nipple.  This strategy is frequently employed to avoid formal mastopexy and its associated risks, provided the inframammary crease is high enough pre surgically to permit some lowering.

Because of the complexity of healing and the multiple factors influencing the precise position of the inframammary fold (which changes over time) post operatively, it is impossible to predict and completely control.  Bottoming out is thus, unfortunately, not an uncommon problem.  Fortunately, it can be fixed.

Breast shapes vary and there are different techniques to create the ideal breast shape.  If a breast is smaller or has an uneven inframammary fold, lowering the inframammary fold may be recommended when placing an implant.  There are many reasons an implant can "bottom out".  Lowering the inframammary fold increases the risk of it bottoming out, but that does not mean it should not be performed to obtain a better breast shape.  Hope this helps.  

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). 

There are instances where a lowering of the inframammary fold (IMF) is entirely appropriate and necessary - without photos there is no way to give you more specific information.  However, this needs to be done cautiously and carefully. Normally this would be discussed with you prior to your operation.  Discuss this with your doctor and perhaps you can get more information regarding your operation.

Fortunately, there are operations to correct this, but these are operations.  Deciding on how to proceed can be a challenge, but if you submit photos, perhaps you can get additional direction.

Best of luck

Vincent Marin, MD

San Diego Plastic Surgeon

With many breast augmentations the fold will be lowered as the breast implant is centered within the breast. The lowering of the fold has more to do with the give and relaxation in the skin envelop of the breast rather than the idea of physically lowering the breast fold. Yes, an attempt to lower the actual fold with a very full implant can result in the implant to bottom out, or even result in a double bubble, though this is more of cause of the pocket problems. What is important now is that your surgeon can fix the situation.

Best of luck,

peterejohnsonmd

Many factors can contribute to bottoming out but lowering the inframammary fold can contribute also.  Bottoming out can be fixed with a surgical procedure.  Good luck!

Can not answer without seeing before and after photos of you. Ask him why he lowered the infra fold. 

I disagree.  I lower the fold as a nearly routine practice in breast augmentation surgery.  Just as the nipple needs to be correctly placed over the implant, and this changes depending on the implant selection...the same is true for the fold.  Now, there are cases where I will reinforce the fold to prevent bottoming out, and there are cases where I'l select a different implant depending on the resulting dimensions...but, very simply, a larger breast has a lower fold and I believe this is an integral part of getting a good result on most patients.

While I sense your frustration, it is a common practice to lower the inframammary fold during a breast augmentation. This usually allows your surgeon to create a given space or pocket to allow your breast implant to settle while avoiding the too commonly seen "high-riding" implants in other patients. However, the amount that the fold is lowered is dependent upon numerous variables, and is usually a very small amount. If it's lowered too much, then patient's run the risk of developing a doubble bubble deformity, implant migration, implant asymmetry, bottoming out, etc. These are factors that your physician should discuss with you prior to surgery, and is dependent upon selecting an appropriate and responsible implant size, and not an arbitrary breast implant size.

Hello and thank you for the question.

On a case-by-case basis, there are indications to lower the inframammary fold in breast augmentation. Changing the fold position is sometimes necessary in order to create balance and symmetry, as a mild and relatively un-noticeable asymmetry in a virgin breast can translate into a significant asymmetry following augmentation. Without seeing the specifics of your particular case, it is difficult to make an accurate assessment.

Best of luck,

Glenn Vallecillos, M.D., F.A.C.S.