I have subglandular 300cc gel implants. Had consultation today for lift. Main concern is visible rippling. Surgeon I consulted today showed me how a lift by repositioning areolas as drawn, and removing some skin (see pict) would greatly improve rippling. I'm all for going the less invasive/costly route but I wonder if I am being foolish not having the implants placed under the muscle as well. Would it make that much of a difference? At 49 I don't need perfection, just want to improve rippling.
Mastopexy to Improve Gel Implant Rippling
Doctor Answers 13
Breast Lif or Mastopexy and Silcone Breast Implants in Los Angeles
As this patient has experienced silicone breast implants can also ripple, especially when placed over the muscle. To lessen breast implant rippling, it is a good idea to try to move them as much as possible under the muscle; at least the superior and medial aspect of them. Breast Lift and Mastopexy can help to a lesser degree by tightening the breast tissue.
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Fat grafting for breast augmentation
You are a good candidate for fat grafting to the breasts. You may even want to later consider a short scar mastopexy similar to the techniques described by Dr. Madeleine LeJour (Belgium) and Dr. Elizabeth Hall-Findley (Banf, Alberta). Fat grafting to the breasts should be done after 4 weeks of preparation with the Brava device (myBrava.com) which is an external breast exanpsion device but since you have implants they could be removed and you could have fat grafting at that time with closure of the capsule pocket. Once healed you would require your first 4 weeks of home treatment with the Brava device followed by a second session of fat grafting to the breast. You may require 2 or more fat grafting treatments to achieve your goal size. This form of treatment would allow you to completely rid yourself of an implant which naturally tends to ripple and be visible beneath thin tissues. Placing the implant under the muscle will only partially correct the rippling problem. Remember I think you'll still likely need a short scar mastopexy but that is a personal decision for you to make.
Rippling after subglandular implants
Rippling and sagging following subglandular implants can be corrected in the following way
1 If saline saline implants are causing rippling ,convert to silicone --preferably smooth moderate profile plus,as this implant is least likely to cause rippling
2 I do not believe that submuscular placement is the solution ,Sub muscular placement can cause abnormal distortion and movement of the implants when the pectoral muscle is tightened.I prefer subfascial placement
3 The sub areolar variation of the circumareolar breast lift has less tendency to stretch.The vertical scar can usually be avoided with this technique,especially if the lower pole is supported with a mesh or dermal sling(Internal Bra )
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Lift over or under the muscle?
A periareolar lift most likely will not correct the visible "rippling" problem. This problem is not only derived from the capsule but it mainly has to do with the adequate amount and quality of the tissues that are covering the implants ( skin, gland, muscle,etc.). My patients have had the best results with a circumvertical lift and replacement of the implant to the submuscular space if the covering tissues are thin.
Rippling after subglandular breast implants
Based on your photos I would recommend converting your implants to a subpectoral location (under the muscle) to minimize your rippling. I would also recommend a circumvertical mastopexy (lollipop lift) to give a nicer contour to your breasts. An areolar lift alone will not give you a very good result.
I recommend consulting with one or more board certified plastic surgeons for a more comprehensive exam and review of your surgical options.
The IDEAL Breast Lift to Minimize Rippling
A few points:
1. The fact that we are seeing rippling / in-folding NOW means that the ripplings of your implants are NOT covered by the amount of breast tissue you posses. IF you had a sufficient amount of breast coverage over the implants, such rippling would exist at the implant level but would not be visible or palpable at the surface. So, you REALLY should consider going UNDER the muscle (In other words, your hunch was right!)
2. A Periareolar lift (the kind drawn on your breast), in MY opinion is the wrong operation if you want to have truly attractive and perky breasts. You already have too much loose skin along the mid and bottom of the breasts. Skin which will NOT be removed or tightened merely by repositioning of the nipple/areola complex. To get a much better result, you will need a variation of the Lollipop Breast Lift (Mastopexy). Please, refer to the enclosed link for an explanation.
Peter A Aldea, MD
Lifts aren't the cure for rippling
Your best chance of fixing the rippling is to go under the muscle. A lift alone would almost certainly leave you disappointed and the periareolar lift marked on you will also leave you disappointed with the inadequate lift and re-shaping of the breast it will give you. You will likely be left with a flat, baggy breast with loose skin in the lower pole and ripples still present.
Breast lift alone not adequate to fix rippling implants
I think you will need more that what is drawn
I don't think you will get enough tightening of the skin with the lift just around your areola. It will take a more formal lift as well as tighten of the internal capsule ( capsuloraphy ) to do the job. This will make more scars on your breast skin, but this is usually well tolerated if the breast are shaped nicely and the wrinkling is better.