What Can I Do to Fix the Rippling/Wrinkling on my Breasts?

You are in a tight spot, literally.  You implants are a bit too wide for your chest wall.  I completely agree with Dr. Baxter, your choices are limited.  If you are not already in a high profile implant, you can consider increasing the profile of the implant (a high profile 800 cc implant is more narrow than a moderate plus profile 800cc implant, and a moderate profle 800cc implant is more narrow than a moderate profile 800 cc implant.  Barring changing the profile or downsizing, Strattice is a viable option.

The primary causes of rippling/wrinkling of the breasts following breast augmentation are:

1. The patient is very thin, with little fat to camouflage the implant.

 2. The implant is placed above the muscle.

3. Saline implants are used.

Replacing the saline implant with a silicone gel implant often improves rippling dramatically. In addition, converting the position of the implant to under the muscle as opposed to over the muscle can also improve upper breast rippling. Finally,, in the patient who is excessively thin, gaining some weight can be helpful. Overinflating a saline implant does not typically eliminate rippling of the implant.

If you're very thin or lean, any type of #implant can display some #wrinkling.  However, #positioning under the muscle may help.  Silicone implants do better than saline in this case. Also, adding a mesh (i.e. #ADM or similar) can help. Also, replacing with smaller implants, skin #tightening and #capsulectomy may also treat #rippling or #wrinkling.

Breast Implant Rippling most often occurs when there is insufficient soft tissue coverage due to little overlying body fat and breast tissue. Implants placed beneath the muscle help to minimize this phenomena but the lower and outside breast (as pectoralis muscle is no longer present), towards the cleavage where the muscle thins out or on top of the breast where breast tissue is often lacking are the most common places to see rippling. It is often accentuated with certain positions (e.g. bending over,or leaning). Most of the time, rippling is felt along the outer side of the breast and the inner side of the breast next to the cleavage. Breast implant waviness (rippling) that is felt but not noticeable to the eye is very common and should not be a concern. However, when rippling is visible, patients are often self-conscious about their appearance.Factors that are associated with increased rippling include:Traditional Saline implants (IDEAL® Saline implants less likely)Textured implantsLarge implantsThin patients with low BMIImplants placed above the musclePrior history of ripplingFactors which are less likely to have rippling include:Heavier and larger breasted womenUsing a highly cohesive form-stabile silicone implants (gummy bear)Smooth implantsSmaller implantsSubmuscular placementOnce rippling occurs it is very difficult to correct. Rippling can be minimized by placing a biologic fabrics (e.g. AlloDerm®, Strattice™, SERI®), submuscular conversion if implants are above the muscle, fat transfer, use of adjacent tissue (muscle or fascia) if available, and in persistent cases implant removal and fat transfer. Seek the care of the best board certified plastic surgeon possible with experience in breast revision surgery.#rippling#breastaugmentation

You have a visible ripple due to inadequate soft tissue coverage over you implant. There may also be an element of scar on the medial aspect of the implant pocket.  I think your best option is to downsize your implant, probably to a lower-profile shape, and add additional tissue thickness with strattice or alloderm grafts  to this area.  Fat grafting may also help, but I'm not sure you currently have a thick enough tissue envelope to permit this technique.  

Your implants are too wide for your breasts creating the ripple, and they need better coverage with soft tissue.  A smaller implant and perhaps graft with fat or dermal matrix should help.

Rippling is avery difficult problem, and is most likely related to the skin of the breast and not the implants.

                  The
combination of large implants in women with inadequate soft tissue coverage can
cause a variety of problems. Your pictures suggest greater problems than just a
medial breast ripple. It appears that your implants are encroaching on the midline
and putting you at risk for a condition known as synmastia, where the breast
merge across the midline obliterating your cleavage.

                  Correction
of the problem will probably require several surgical maneuvers. These include
the replacement of your current breast implants with smaller implants with a
decreased transverse dimensions. The use of an acellular
matrix such as alloderm or strattice to function as an internal bra for
support. It may also be necessary to perform a breast lift if decreasing breast
size results in breast sag.

                  It’s
important that you discuss your concerns with your plastic surgeon so a
treatment plan can be formulated. It’s also important to wait 3-6 months before
proceeding with revisional surgery. 

The less natural tissue coverage over a breast implant, the greater the risk of rippling. By natural tissue I mean your skin, breast tissue, fatty tissue and muscle.  Silicone breast implants have the least risk of causing rippling but it can still occur. By performing a dual plane, you still have muscle coverage over the upper half of the implant. The options to help improve your rippling include increasing the coverage over the implant with a ADM (this is an acellular dermal matrix such as Alloderm).  Another option would be switching to a more highly cohesive gel implant however this would give your breasts a firmer feel.  I would discuss these options with your Board Certified Plastic Surgeon.

From the pictures, it appears that you have rippling caused by thin skin.  So, the treatment would be to increased the amount of tissue or volume between the implant and your skin.  A treatment option would be placement of Alloderm or Strattice between the implant and your skin.  However, this may not correct the rippling completely.  Another treatment may be fat grafting to the area to increase the tissue thickness.  However, you may just have skin that is too thin to completely mask the rippling.

 

Good Luck.