I Had 4 Previous Revisions and then Finally a Lift. Now There Is Rippling, What Should I Do?

I still have a huge problem, I had major sagging before and bottoming out. My last surgeon (of 3) fixed the sagging with a full lift. Now I have rippling which I never had before, and the right implant is still off to the center a bit causing some issues. I shouldn't have rippling because I have my own breast tissue, even though the surgeon removed 50 cc's of my tissue during surgery. He is going to tighten the skin on the bottom but does not say it will fix this.

Doctor Answers (14)

Rippling of Breast Implants?

+1

Thank you for the question.

Palpability  and rippling of breast implants may be related to several factors. These include the amount of soft tissue and breast tissue coverage over the breast implants, the position of the breast implants (submuscular versus sub glandular), the type of implants (saline versus silicone), and the degree of overfilling of saline filled implants. Generally, weight loss will extension weight any rippling/palpability  of the implants.  Deflation of the implants will also increase the rippling/palpability of the implant.

Correction of the rippling may involve further surgery including implant pocket exchange if possible ( sub glandular to submuscular), implant exchange if possible (saline to silicone), and/or the use of allograft to provide an additional layer of tissue between the implant and the patient's skin.  

Given your complicated  past surgical history it would behoove you to be examined in person  by a board-certified plastic surgeon well-versed in revisionary breast augmentation surgery.

I hope this helps.


San Diego Plastic Surgeon
5.0 out of 5 stars 681 reviews

4 revisions

+1
I agree with Dr Aldea. Each procedure bears its own risk. My mentor used to say that perfect is the enemy of good. Surgery is not the equivalent of changing hair color. It is serious business and sometimes saying no or that the implants or procedure a patient wants isn't what I would recommend isn't easy but it may be the right thing for all concerned. More surgery may produce ore or different problems and it is important to have a good reality check as to the risks and benefits of a fifth operation.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 8 reviews

Rippling post mastopexy

+1

This may be due to saline implants.Also the implant pocket can be revised so you can move the right implant to a more normal position.

Robert Brueck, MD
Fort Myers Plastic Surgeon
5.0 out of 5 stars 13 reviews

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Multiple revisions for breast surgery.

+1

Thank you for your post and the photos. Rippling is simply the ability to see the implant through thin tissue. Even though a person may have breast tissue, after a lift, this tissue is tightened and this tightening will always thin the tissue to some degree. The underlying implant (and usually more common with saline implants) can then be visible. To correct this, the best options involve placing the implants under the muscle and/or adding a dermal matrix such as Strattice. This allow for better soft tissue coverage and camouflage of the underlying implant. Fat grafting can also improve this issue but is less reliable. It is important to note that every revision you have is impacted by the previous surgeries which make the current revision less predictable and more fraught with risk. I recommend consulting with several Board Certified Plastic Surgeons who specialize in breast surgery before proceeding with any more surgery.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 8 reviews

Solution for Implant Rippling

+1

Visible rippling can happen when the implant is close to the skin and has little breast tissue coverage.  This is seen more often with saline implants but can occur with silicone as well. If you have had several surgeries and the implants are still positioned incorrectly the best solution is to use a biocompatible material such as Alloderm or Strattice which cover and support the implants.  The advantage of using one of these materials is that they can also be used to create new pockets to reposition the implant correctly and form a natural cleavage area.   The use of the additional material may end up costing you more, however it should be worth it to achieve a good long lasting result that you are satisfied with.

Adam Hamawy, MD
Princeton Plastic Surgeon
5.0 out of 5 stars 13 reviews

Multiple revisions usually get farther and farther from perfect

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Please read and re-read Dr. Aldea's note as it excellently describes the problem we see in many patients.  I will add to that the fact that inherently, with each revision the patient's expectations invariably go UP and the reality of the potential result often can go DOWN because of scar tissue etc.  This creates a growing EXPECTATION MISMATCH which is not resolved by continually changing surgeons thinking that someone will finally have the magic to give you a perfect result.

You demonstrate by saying that you have a "huge" problem that you do not understand that further revision could actually make matters worse.  Yes, revisions are not guaranteed to make things better.  And tightening the skin isn't going to change the ripples you have.

In my practice, when I meet a patient like you, I try to get them to focus on small issues that can be imporved, not on trying to hit a home run the fourth time around.  It is best to do nothing than to make the problem worse.  Be very careful about where your expectations are because they may be unreachable.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 47 reviews

Breast Revision and Rippling

+1

Sorry to hear about your troubles. But, there are potential solutions.

From what I can glean from your photos, to correct your right implant from moving too far off to the side (if that is what you mean by "off center"), your implant pocket on the right will need to be adjusted and made more narrow. To correct the rippling on the left, you need more thickness of your breast to camouflage the implant rippling; if your implants are saline, I would also switch to silicone to reduce this effect as well. As far as camouflage, your options are fat grafting to thicken the breast tissue or internal coverage with a biologic mesh like Alloderm or similar material. The mesh options allow internal coverage of the implant and can supply a hammock-like support as well.

Unfortunately, another revision will be necessary to correct your remaining breast problems. But, with a measure of success, I think you should end up with a good result that you will be happy with. Make sure whoever you seek has a complete gameplan to correct your issues and you have a clear understanding about what their policies are regarding (God forbid) more revisions in the future.

Derek Lou, MD
Houston Plastic Surgeon
5.0 out of 5 stars 6 reviews

Rippling following breast augmentation

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Rippling can be seen with any type of implant.

It is more common with saline implants, and textured implants

Rippling occurs least commonly with smooth round moderate profile plus silicone gel implants

Rippling is also related to the overlying tissues.The thinner the tissues the greater th chance of rippling

The overlying tissues can be thickened with fat injectionsor dermal grafts.These grafts are either from human donors , animal sources or synthetic materials

.Injectables such as Sculptra are being investigated in the treatment of breast implant rippling

Hilton Becker, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 5 reviews

You need soft tissue coverage and fat grafting is an option

+1
I am sorry that you had to go through multiple operations and still have problems with your implants. You do not have enough breast tissue to cover the implants. I would recommend fat grafting over the implant to provide more coverage. For patient with similar problems I have done fat grafting many times. You can refer to my web site for more information.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
5.0 out of 5 stars 51 reviews

Implants ripple after four breast revisions

+1

Even with a silicone gel breast implant, it may be possible to see a small fold or ripple over a breast implant. The more breast tissue to cover the better, though breast implants and natural breasts all have imperfections and limitations. Your pictures show a result that is very good, and probably should be viewed as good enough.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 26 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.