BA 5/2012 Natrelle Teardrop Subglandular. Second Opinion For Visible Knuckling? (photo)

I had BA in May 2012 with natrelle teardrop implants 360mm subglandularly. Since healing I have palpable folds and edges in both breasts. Right breast is worse and has a visible knuckle in cleavage area. Fat grafting was done and did not help. Now my surgeon wants to reopen my pockets and enlarge them mesially and replace same implants under local anaesthesia. I am concerned this may not work and also about rotation since there will not be a new pocket to adhere to. What do you recommend?

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Natrelle dents cleavage fat graft

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10 Doctor Answers | Asked by Amy284

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Second Opinion For Visible Knuckling?

Visible rippling is doe to thin tissue. We generally place implants under the muscle for better coverage and to hide potential wrinkling and rippling from being visible. Saline implants show rippling more than gel...you do not say which you have. Textured implants may, depending on type (and certainly textured saline), show rippling more than smooth, and since you say you have teardrop implants those are always textured. I think you should consider having your implants placed... more

Subglanduar implants

Dear Amy284, Your issues stem from the subglandular position of your implants. It is rare that implants do well in front of the muscle. It is a misconception that the new gummy bear implants cause less rippling. They may cause less number of ripples, however, the ones that do form are much more severe than in smooth implants. Your only solution that would work both in the short term as well as long term is to convert your implant position to... more

Treatment of Visible "Knuckling” of Breast Implant?

Thank you for the question and pictures. Although it is not possible to give you precise advise online, generally speaking patients in your situation may benefit from breast reaugmentation in the sub muscular position and/or the use of allograft material. I would differ from your plastic surgeon in that I would not suggest additional dissection in the sub glandular position; this plan will expose you to additional problems with rippling/visible “knuckling” of the... more

Visible Knuckling

I would advise replacing these in the submuscular position with smooth round gel implants. The alternative, which may be more expensive, would be to cover the rippled area with Strattice, an acellular dermal matrix. I concur with your concerns about the offered solution being unsuccessful. All the best.

Ripples in my implants.

Thanks for your question. I think you have a few options. The textured implants can cause rippling. I agree that a smooth round implant may help. Also you may want to change the implant out to a submuscular position. Also the new gummy bear implants may be an option. They can be placed in the same position of your current implants. They may be the simplest option. Hope this helps.

BA 5/2012 Natrelle Teardrop Subglandular. Second Opinion For Visible Knuckling? (photo)

I would replace them with smooth round implants If you are very satisfied with your current implants and wish to keep them ,then you may want to consider dermal grafting or mesh

Teardrop Implants in Subglandular Plane

The rippling can be improved by submuscular placement, fat grafting, the placement of a dermal matrix, switch to a smooth silicone implant and appropriate pocket dissection. Kenneth Hughes, MD Los Angeles, CA

BA 5/2012 Natrelle Teardrop Subglandular. Second Opinion For Visible Knuckling?

What is being demonstrated is the risks of above muscle implant placement. Your surgeon tried to correct with fat grafting. Next step is changing the placement to below the muscle.

Implant issues

You are seeing visible ridging of the implants. Sometimes placing the implants under the muscle can help. Also strattice may be a reasonable choice to camouflage the implant edge.

Steven Wallach, MD

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Manhattan Plastic Surgeon

Visible implant edge

Are the two photos before and after fat grafting? The second photos seem to hide the knuckle. Here are some other options to discuss- what about partial subpectoral coverage? What about a sheet of acellular dermis? Each of these have their own pros and cons.