What Kind of Revision Do I Need for Bottoming out and Rippling After Augmentation and Lift 1 Yr Ago?

I am 49,5'9",128lbs,breastfed 7 children-34B prebaby, 36D-DD pregnancy/nursing, 34A post.I had BA/donut lift,subfasical,340cc textured silicone(34D)then experienced rippling by 3 months postop. At 7 months post, PS moved implants to dual plane with vertical lift. They looked good but by 3 months post, they began rippling and by 5 months bottoming out. It is 1 yr post - rippling bad and no upper pole fullness, but no contracture. I have little breast tissue or chest fat. Suggestions?

Doctor Answers (9)

Rippling even with Subpectoral Placement

+2

From your photos you seem to have very little fat on your body including your breasts. I assume these are saline implants. The third photo and fourth photo shows your current condition. i would like you to gain some weight and soft tissue coverage of your implants but that probably won't happen. The 'bottoming out" does not appear to be severe. The nipples have migrated north so I would remove skin with a horizontal excision at the crease level to level the nipple/areolar complex.This will also shift the implant to the upper pole and improve this area.  At the same time I would recommend replacement with Round Silicone Gel Implants. It may not totally correct the rippling but will result in a better appearance with less rippling.

Hope this helps!


Orlando Plastic Surgeon
5.0 out of 5 stars 2 reviews

What Kind of Revision Do I Need for Bottoming out and Rippling After Augmentation and Lift 1 Yr Ago?

+1

Textured gel implants may show more rippling in patients with thin tissue than smooth gel implants, so that might help.  Despite being subpectoral, your breasts are naturally low on your chest, so the pectoralis muscle is not giving you much additional tissue coverage farther down on the breast.  You do have some drop out, though not severe.  You may benefit from Strattice support to the lower breast to try to prevent recurrent drop out and add some additional thickness of tissue to camouflage the rippling, and changing from textured to smooth surface silicone gel implants. Ultimately, there are some patients with very thin tissue and larger skin envelopes that "need" implants to fill out the skin but who do not have enough tissue thickness to hide the edges and irregularities of even gel implants. Strattice, although expensive, may help these patients to some degree, but their results may never be perfect. 

Robert M. Grenley, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 70 reviews

Large breast implants not a good option for thin women

+1

Thin women with significant tissue loss from breast feeding, pregnancy or weight loss often desire a curvy shape.  However, there are some signficant drawbacks to exceeding the tissue "load" ability of the breast, one of them being even further thinning of what breast tissue is left.  Stretching and thinning will lead to severe rippling and bottoming out.  In these situations I recommend:

  1. Smaller silicone filled smooth walled implants:  sizing will depend on particular anatomy, but in general no larger than a final C cup
  2. Capsulorraphy, using self derived skin "bra" from skin reduction during the lift.

The critical element of a successfull revision in these situations is to not exceed the load capacity of the residual breast tissue and skin envelope, therefore it is necessary to reduce implant size.

Mario Diana, MD
San Antonio Plastic Surgeon
4.5 out of 5 stars 24 reviews

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Bottoming out

+1

Your case is complicated and I agree that you have very little body fat.   It is difficult to say exactly without examining you, but probably I would suggest capsulorrhaphy (internal sutures for better pocket placement) to assist with the bottoming out as well as AlloGraft to assist with the rippling.  I would also change your saline implants for silicone gel.  Seek advice from a board certified plastic surgeon who has experience with this type of surgery.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 753 reviews

What Kind of Revision Do I Need for Bottoming out and Rippling After Augmentation and Lift 1 Yr Ago?

+1

Thanks for posting your photos and history. You have a very difficult issue. There is no perfect answer. I might suggest a re lift with upper pole fat grafts (if you have any fat?). Other wise the Strattice is quite expensive for the very high possibility of a no result. I would try the re lift first, simple first. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 62 reviews

Sometimes a breast augmentation won't be a home run

+1

I have learned after 20+ years of doing this that some body types are especially hard to get a great breast augmentation and you are one of them.  Over 40, super thin with no breast tissue, you have almost no chance of not having implant problems especially the bigger you go.  Strattice may help but you will always have ripples and may ever get the result you want. 

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 49 reviews

Correction of bottoming out after breast augmentation

+1
There are a couple of options to help with your problem of bottoming-out and rippling. One option is to perform a capsulorraphy, where the pocket is expanded superiorly and closed off inferiorly. This can be accomplished with a running suture technique or with a cadaver graft. Using the suture technique seems to work extremely well without the added cost of the grafts. If you still have textured implants you might benefit by replacing them with a smooth walled implants that tend to ripple less.

Robert M. Jensen, MD
Medford Plastic Surgeon
4.5 out of 5 stars 20 reviews

Fat grafting and pocket revision and smaller implant may help

+1

Your breast tissue is very thin and going above the muscle make the situation worse. Your breast present a difficult situation. there is minimal soft tissue,loss of skin elasticity and implants bottoming out. I have revised patient in your situation with combination of fat grafting(you do not have much fat), pocket and mastopexy revision and going with smaller implants. You can check my web site for examples.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
5.0 out of 5 stars 58 reviews

Strattice graft for breast implant bottoming out and rippling

+1

Recurrent bottoming out and rippling with breast implants is due to loss of tissue support, and the Strattice acellular dermal matrix graft can be used to correct this by forming a living internal bra. (Alloderm can also be used for this but is mostly used in breast reconstruction.) With the dual plane technique, the pectoral muscle is detached from the rib cage so it covers the upper part of the breast implant but there is nothing holding it up from the bottom except thin skin. The Strattice graft bridges from the bottom edge of the breast to to muscle for a secure pocket. Over time it becomes incorporated as living tissue, so you can think of it as a living internal bra.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 25 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.