Lowering the Inframammary Fold During a Breast Augmentation

Breast Augmentation

Believe it or not, the crease (or inframammary fold aka IMF) under your breast is an important anatomical landmark! It is a key part of how your breasts look, so sometimes it requires a surgical tweak.

Most of the time, when you place a breast implant into a breast the fold will naturally lower as the breast implant is centered within the breast. But sometimes a surgeon will advise that the natural breast fold is lowered surgically.

An IMF is usually lowered so that the implant rests at a level that appears natural relative to the position of the nipple and areola.

Lowering the crease gives the surgeon more skin below the nipple to help place the implant in it's ideal position... centered directly behind the nipple-areola complex (NAC).

Lowering the Inframammary Fold

Because we all have unique anatomies the decision to lower an IMF is made on a case-by-case basis.

Lowering the Inframammary Fold

The reasons why a surgeon may recommend lowering a natural breast crease include:

  • To create balance and symmetry - most breasts are slightly asymmetric (sisters not twins!) and require a small (or sometimes more dramatic) surgical adjustment. This may mean only one crease is lowered, or one a bit and the other a lot.

  • To accommodate a breast implant in small breasts - small breasts have a very short distance from the fold to the nipple and to get the best natural-looking result the crease may need to be lowered.

  • To lift mildly sagging breasts - when the nipple is low on your breast because of some drooping extra skin needed below the nipple to accommodate the implant.

  • To place breast implants in tuberous breasts - lowering the fold is frequently necessary in constricted or tuberous breasts as the lower pole is tight and limited in size (which give the breasts a pointy/narrow shape)

You may also hear about the IMF being lowered to accommodate a larger breast implant. Most surgeons wouldn't recommend this though and should steer you towards a higher profile.

If a surgeon recommends lowering the IMF to accommodate a larger implant it should ring warning bells that the implant is too big for your anatomy.

When Not to lower your Inframammary Fold

The caution with lowering the IMF is that in some cases, lowering the fold can result in a poor outcome.

Lowering the IMF is not a common occurrence. The majority of surgeons favor NOT lowering creases, usually because there's the potential for creating certain aesthetic complications.

Breast Implants

The risks of lowering a crease are essentially undercorrection or overcorrection.

Not low enough and the breast implant will end up riding high (which would need correcting by releasing the IMF more).

Too low and the augmented breast will appear 'bottomed out', where the breast implant slips below the IMF and the nipple appears to sit too high on the breast. A new IMF made too low can also cause 'double bubble'.

Be sure to discuss with your surgeon why they're recommending lowering the IMF, and establish what they do in their practice to minimize the risks of lowering an IMF (which may included wearing a specific underwire bra to give the new fold strength and/or using a special surgical material to reinforce the newly positioned fold).

Lowering your natural breast crease may be an option your surgeon considers to aid positioning your implants to yield the best aesthetic results... it's all depends what anatomy and your breast augmentation goals!

Thoughts from Dr. Glenn Davis

The position of the fold underneath the breast (or IMF) is a key anatomical landmark. It helps determine the ideal location of the nipple and areola, and in some women, there may be a degree of asymmetry between the two sides.

In those instances, we would discuss the pros and cons of adjusting (likely lowering) the fold on one side in order to achieve the best possible symmetry with placement of the implants.