The crease, or inframammary fold (IMF), incision is one of the most common incisions currently used for breast augmentation. Like the nipple (areola) incision, this incision site allows the implant to be placed over, partially under, or completely under the muscle, and allows for revision, adjustment and removal of breast implants without having to make a separate incision. This incision pattern also allows the plastic surgeon to work within close proximity of the breast, meaning more control over placement of the implant. When using this incision, the implants do not pass through the breast ducts, which are known to harbor bacteria, and this has been found to decrease the rate of capsular contracture, or scarring around the breast implant.
Inframammary fold incision basics
- The incision is made in, above or below the inframammary fold, commonly known as the crease.
- If the incision is properly placed, the scar should not be visible, with the exception of being in a horizontal position. The surgeon usually tries to situate the incision so that it will fall just above the inframammary fold. This is done in order to prevent the scar being seen, for example, if your bathing suit top rides up. In small breasts, the incision may be placed initially below the crease, which will eventually blend with the IMF.
- The surgeon will estimate where the incision will be in relation to the new crease; otherwise, the scars could ride high on the breast and be very visible, or they could be placed too low, which would also make them visible.
- Incision length will vary with choice of implant. Large implants and cohesive gel implants (gummy bear) may need longer incisions, whereas saline implants can be placed through very short incisions.
Inframammary incision pros and cons
- One advantage to this incision is that virtually all revisions, such as for capsular contracture, symmastia, bottoming out, etc., can all be performed via this incision.
- If you have the transaxillary incision and need a revision due to a problem, chances are you will need to use a different incision, which means more scars on the breasts. If you start with the crease incision and have a problem, you will still end up with the two incisions you started with, instead of one or two new scars.
- One disadvantage is that the surgeon—in cases in which there is little breast tissue or little to no natural crease—has to estimate as to where to place the incision. However, experienced plastic surgeons are very good with this particular incision, and having a misplaced crease incision is rarely a problem.
- Another disadvantage is going up or down substantially in size. If you decide you want much larger implants, your crease may have to be lowered, though this is rare. This is done so that the implant can be centered behind the nipple. Going much bigger may mean that your incision scars from your previous surgery may be higher on the breast. The same rule applies with going smaller in size. If you go smaller, the crease may have to be raised, which means the incision scars will be lower than they were initially. However, this can be easily removed.
- If you decide to have your breast implants permanently removed, the crease incision will be visible, no matter what.
Crease, or IMF, incisions for breast augmentation are predictable and reliable, with very few disadvantages.