Understanding Lowering of a Crease

[Rosebud11]

Hi Dr. Mele,

I am trying to understand how lowering of a crease works. I found out from my PS at my 6 week post op appointment, which was last week, that the crease on my left side had been lowered and now that I am thinking about it, I have more questions.

My left side was always higher and smaller even prior to my surgery, however, after surgery it is still higher and smaller. It actually measures about 1/2 inch smaller, and it actually does not even look like the crease was lowered on the left side. I discussed the fact that my asymmetry still exists with my PS and he said I need to wait 5 months to see if it will all even out, if not he will do a revision, which means he will put a bigger implant in the left side. I currently only have a 50cc difference between the two sides and I may need 100. I have 450 in my left and 400 in my right. I think my smaller side was about 1/2 cup smaller or maybe more. I'm not really sure.

It does seem reasonable to wait it out for 5 months and see if things even up. I just want to understand more.

My question is, is it normal for a crease that has been lowered to take a while to even out? It looks like it is about 1/2 inch higher, will it drop down this much over time? There is no double bubble or anything there. And, if the smaller breast is measuring 1/2 inch smaller and is higher is is possible that it could get bigger and go lower? Or should I just prepare my mind and save up some money for a revision surgery in January? My PS said that most of my dropping is done.

I know I was a difficult asymmetry case, I trust my PS, I just was curious about all this and it is frustrating having one side smaller than the other...now that they are bigger it is actually more noticeable in clothes then when they were smaller and one of my main goals for getting this surgery was to help my asymmetry which has bothered me since I was a teen.

Thanks for any information you can provide!

[Dr. Mele]

Dear Rosebud11:

To lower a breast mound, the inframammary fold (IMF) is lowered. The IMF is a complex structure. In the simplest terms, it is where the skin of the breast attaches to deep structures to define the lower breast contour. It supports the bottom of the breast.

If you were smaller and higher on the left there are several reasons why the left breast should still be higher at 6 weeks post op.

1) The skin is tighter. there is just less of it so it holds the implant higher and more firmly.

2) The muscle is tighter. If you went behind the muscle with a larger implant there is less space for it. The muscle tends to go into spasm after surgery further lifting the implant towards the shoulder.

3) The fold was higher before surgery. It is a delicate procedure to lower the IMF, especially if the implants are behind the muscle. Too low and a double bubble develops, not enough and it remains high. Remaining high is the lesser of the two evils however.

Sometimes there are fibers in the skin that work like underwire. Even when fully released this type of tissue can support the breast and keep the implant high. This, sometimes is not fixable.

There are several reasons to wait. If the IMF was adequately released it may take 6 to 12 months for the skin, muscle and other tissues to relax enough for the implant to drop. It is important to keep the lower aspect of the breast pocket open while waiting so that the capsule will allow the implant to drop when this happens. Displacement exercises may be helpful, but you will want to consult with your plastic surgeon first.

Operating soon after surgery can lead to an increase in scar formation. It is good to let the area heal before injuring it again. Also if you are "corrected" too soon, and let say it looks "perfect", when the tissues do relax ... it will be too low. So for predictability's sake, you want to wait. By waiting you may find you don't need another surgery. If at 6 months the implant is still dropping, I would recommending waiting longer.

[Rosebud11]

Thanks for the very thorough explanation.

I have one more question....lets say all works out well and the IMF was lowered the proper amount and it evens out. Does this mean that once the skin loosens and the muscle relaxes more that my left side will no longer be smaller than the right side? I mean, could the IMF lower but the breast still be smaller and still need more cc's?

I am really hoping to not have to do another surgery!

Thanks so much for your help!

[Dr. Mele]

It is possible that as the tissues relax the size will increase; however, it is more likely that the left side will still appear smaller. Time will tell. I can't really make a prediction without ever seeing you.

[Rosebud11]

Thanks Dr. Mele!