Hello and thank you for your question and picture. I agree with your assessment of your breast bone width. So for starters an anatomically shaped (tear drop) implant may provide a more natural looking augmentation for you than a round implant. To address the rippling, you may want to consider using an acellular dermal matrix around the implant or fat grafting to thicken your tissue and better hide the implant .
The most important thing for you to do is consult with an experienced plastic surgeon who you feel comfortable can deliver the results you desire.
Best of luck to you,
Ruth Celestin, MD
Thanks for sharing your question.
Much depends on your exam and where the concern you have is. In many cases revision breast augmentation with a tissue matrix like alloderm can provide additional thickness and improve the appearance of rippling. Fat transfer can be considered, and should be performed by surgeons with extensive experience in this procedure.
your posted photo appears as a pre op??? Please add additional photos. But very unusual for ripples in silicones/cohesives...
You have a few options. In order to remove the possibility of rippling, do not have an implant and have some fat transfers to increase your volume. If you are looking for an augmented "look" you will want to consider some combination of fat transfer to thicken the soft tissues above the implant or acellular dermis mesh to thicken the soft tissues. An anatomically shaped implant will also help more than a round one.
Rippling will occur as a result of a thin soft tissue coverage. Fat injection can soften this and so can strattice a acellular dermal matrix.
Rippling can occur from thinness around the implant. As you have experienced, it can occur with both saline and silicone implants. If your tissues are thin, and your bones show, then your implant can show too. To minimize rippling, adding coverage is essential. If the sub muscular pocket did not help, then adding fat may be an option, provided you have a donor site for liposuction. Weight gain also helps, but for most women, that is not an ideal option. Smaller implants also cause less tissue stretch and therefore may ripple less. I would recommend additional consultations with board certified plastic surgeons to determine the best surgical plan.
There are two types of rippling, vertical striations and side rippling. The more tissue you have the less chance for rippling. The more filled your implant is the less chance for vertical rippling. The larger you go the more chance for rippling. Finally under the muscle would significantly reduce vertical rippling as there is more tissue to cover the upper pole of the breast. You are very thin so right away I would never place implants above the muscle. Your nipples are also far apart. So if you want decent cleavage you may chose a slightly wider implant which will improve cleavage, but try to stay within 300 cc. I would recommend the Mentor MP+ type of smooth silicone implant as they are the most filled compared to Natrelle or Sientra. I would also try to stay away from textured silicone implants as they ripple more compared to their smooth counterparts. If the MP+ still ripples then I would try adding fat to the areas you are rippling in. The other choice is to gain a few pounds, as a little bit of body fat goes a long way to reduce rippling in implants.
Fat grafting is an option but it is very technique dependent so you should find a board certified plastic surgeon who has significant experience with this procedure.