Is a Violation of the Inframammary Fold (IMF) Considered Malpractice?

In November 2009, I decided to replace 15 year old saline implants after being told by a cosmetic surgeon that they were deflating. The doctor convinced me that I would be much happier with the results of silicone implants. After 8 weeks, my implants bottomed out and I now have a double bubble. A consultation with another surgeon has suggested that the doctor attempted to lower my IMF. I have been left in pain and discomfort with breasts that feel like they are hanging off my body.

Doctor Answers 14

Breast Implant Position and the Double Bubble

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When an implant falls beneath the natural breast crease, two curves on the lower breast may be seen.  The top curve is usually the bottom of the natural breast tissue.  The lower curve is the bottom of the implant.  This usually occurs in low breasts, or breasts with strong breast creases which have not been released.    It is likely that a revisional procedure may be useful.  Options include capsulorrhapy (re-creation of a crease with sutures), or fat grafting (injecting fat into the depression between the two curves).  It will be important to consult with your board-certified plastic surgeon to see what options are best for you.  Best wishes!

Los Angeles Plastic Surgeon
4.8 out of 5 stars 34 reviews

The Breast fold

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Lowering the infra-mammary fold is part of the procedure with a breast augmentation. 

A breast augmentation lowers the fold. A breast lift or reduction raises the fold. This is normal and appropriate.

It is possible the infra-mammary fold may be excessively lowered. Should that occur it may be corrected.

Not malpractice

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It is not unusual for the IMF to be lower during breast augmentation and it is not considered malpractice. I recommend you ask your original surgeon for your records and have them examined by a professional to see if any malpractice actually occurred.

Infra-mammary crease scarring

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Usually, the incision is made in the infra-mammary fold and, if you need to lower it to widen the base, the scar will rise up onto the bottom of the breast. If the tissues are released properly,you would not have a double bubble. "Bottoming out" is not a double bubble nor does it cause one. Without photographs, your condition cannot be evaluated but I wish you the best of luck in correcting it. As described, I would not consider the situation you describe as malpractice.

Bottoming out after a breast augmentation

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Lowering of the fold to adjust for volume is not uncommon and is often done in the event that you require adjustment of shape or volume .  It is done routinely with a tubular breast deformity.  There are solutions to your resultant issue but pictures would help to define the exact solution(s).

All the best,

Talmage J. Raine MD FACS

Talmage J. Raine, MD, FACS
Chicago Plastic Surgeon

Violating The Breast Fold

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Lowering the breast fold is sometimes performed and is certainly not malpractice. I suspect you have large subpectoral gel implants. Your problem can be corrected by possible implant exchange and capsulorraphy but without photos and an examination, I am only guessing. Was you "cosmetic surgeon" a board certified plastic surgeon and a member of ASPS?

Richard Linderman, MD
Indianapolis Plastic Surgeon

Lowering the fold in breast implant surgery

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In general, I try to limit manipulating the IMF when possible to minimize this particular complication but it can be unavoidable as a required step. It's a well described manuever that's withing standard of care for breast surgery otherwise, so it is not a de facto instance of medical malpractice or negligence

Double bubble

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Many surgeons purposefully lower the fold so that they can match the folds better and sometiems treat tuberous deformities. Also implants can spontaneously fall below the fold in some patients.

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

Is a Violation of the Inframammary Fold (IMF) Considered Malpractice

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No it is not. In fact in many conditions, such as tuberous or constricted breasts, this isconsidered an essential part of the operation.

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

Inframammary Fold Disruption (Bottoming Out)

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This unfortunately does happen with this surgery and is correctable.  The fold is sometimes lowered to the desired position, but it does sometimes drop, either from too large of an implant for the body or inadvertently.  This does not mean that there was malpractice.

I would discuss the problem with your plastic surgeon and come to a resolution.

Good luck.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 88 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.