Have Mentor round moderate saline implants 325 filled to 375. I'm 5'7", 123.6 lbs, lean, not much dense breast tissue, thin skin. Originally A cup. I work out regularly. Have rippling,wrinkling on sides, visibility & palpability. Implants under muscle. Considering switching to Mentor Memorygel moderate plus. Do I go with a smaller implant (i.e., 350cc) or go with a larger implant (i.e., 400cc or 450cc) to alleviate issues? Wouldn't mind being slightly bigger. Doc says HP not for me.
Redo Implants to Fix Wrinkles/Rippling?
Doctor Answers (12)
How to fix implant rippling
Rippling with implants is a common issue. It is usually seen in thinner women without out much natural breast tissue who have elected to have saline implants. Because of the low viscosity of the saline compared to silicone gel implants, the shell of the implant is easier to deform. Overfilling (as was done in your case) can help counter this effect, although, it can lead to scalloping of the implant (think ripples that don't move).
There are solutions for rippling, although they are all surgical. Switching from to silicone gel implant will help. However, if your tissue is very thin, you may need a dermal matrix interposed to camouflage the implant. I typically use a product known as AlloDerm or Strattice. Another option is fat grafting to add tissue volume. Going smaller may help as well, but if you are happy with the current size, I would recommend keeping the same size implants as the ones you have are not considered large.
To treat implant rippling you can choose a more cohesive gel or fat grafting to add fat coverage on top of the implant.
at 5'7" and 123lb you're pretty skinny and therefore any rippling will be more visible than in a heavier patient. Thus you have two problems: an implant that is rippling, and skinny body that does not hide implant imperfections well. To address the first problem, you can chose to go with a more cohesive (harder) implant. It feels less natural but has less rippling. To address the second problem, if you have any areas that can be used to collect fat (at your height and weight that may be unlikely) fat can be injected under the skin over the rippled area to cover up the rippling. It is a technique that is gaining a lot of popularity because of it's results. However, once again, you need to have sufficient fat that can be used for this purpose.
Martin Jugenburg, MD
Silicone gel breast implants under the muscle usually best solution for saline implant visible folds
Thank you for your question. Saline breast implants are notorious for causing visible rippling in the skin especially and then people without much fat or breast tissue. Once rippling has happened the recommended solution is usually to place silicon gel implants beneath the muscle. Gel implants 10 to have less rippling than saline implants. Most likely you will want a slightly largernew implant to compensate for the stretching that occurred from your previous saline breast implants.
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If your implants are under the muscle, then switching to silicone is the simplest option, and will certainly help. I would go with the same size or larger.
Rippling of breast implants
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 implants.
Having discussed these issues, PREVENTION of rippling/probability is of critical importance.
Much of the final “look” achieved after breast augmentation surgery depends on several factors:
1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the preoperative breast appearance the more likely the breast augmentation “look” and "feel" will be optimal.
2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing long-term well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone) or model (low/moderate/high profile) of implant. Make sure you're working with a well experienced board-certified plastic surgeon.
3. The type of implant used may determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have. If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants. If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result. On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference. Patients may need an MRI to diagnose a silicone gel rupture. Saline implants are also less expensive than the silicone gel implants. Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants. On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational. As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.
4. The size and model of breast implant used may make a significant difference in the final outcome, including the presence of rippling/palpability of the implants.
I hope this helps.
Palpability and rippling of implants
Rippling and palpability are related to the thin soft tissue coverage over the implant. Yes, silicone may preduce these symptoms, and placing them under the muscle may help as well, but alloderm may be necessary to add additional coverage.
Correcting Palpable and Visible Augmented Breast Rippling
Regarding: "Redo Implants to Fix Wrinkles/Rippling?
Have Mentor round moderate saline implants 325 filled to 375. I'm 5'7", 123.6 lbs, lean, not much dense breast tissue, thin skin. Originally A cup. I work out regularly. Have rippling,wrinkling on sides, visibility & palpability. Implants under muscle. Considering switching to Mentor Memorygel moderate plus. Do I go with a smaller implant (i.e., 350cc) or go with a larger implant (i.e., 400cc or 450cc) to alleviate issues? Wouldn't mind being slightly bigger. Doc says HP not for me"
The prime reason for your "rippling,wrinkling on sides, visibility & palpability" is that with a A cup with thin skin and not much breast skin you had a pair of 375cc saline implants placed which, as could be predicted on your initial examination, are NOT covered by your breast tissue. Since ALL breast implants (Saline more than silicone gel) ripple to get attractive results, the implants chosen must conform to the breast size and be covered by it. If the implant extends beyond the coverage of the breast its folds are under the skin to be seen and felt.
The answer therefore is NOT in getting a larger implant but in getting a better implant (silicone gel), which is smaller and consider improving the cover by adding an ADM (acellular dermal matrix) such as Strattice or Alloderm.
Based on your examination a Mentor HP GEL 350cc may be suitable. Discuss this with your surgeon,
Dr. Peter Aldea
How to minimize risk of rippling after breast augmentation
In my opinion, there are several issues which can be considered in order to minimize risk of breast implant rippling.
First, pick an implant which fits within the dimensions of your breast. If the implant is too wide, it will push against the side of your breast, thus increasing the risk of rippling.
If choosing saline implant, the implant should ideally be filled to its maximum recommended volume or even slightly over-filled.
Silicone implants will have less chance of rippling than saline.
Do not use textured implants as the risk of rippling is higher than smooth implants.
Best of Luck.
Visible and palpable saline implant wrinkles and ripples
The high profile implants have a lower tendency to ripple and I would possibly adivse the use of a 350 high profile silicone gel implant to minimize the visibility of the wrinkling. Fat grafting is an option but not without risks and I would advise proceeding with implant exchange first.
How to address breast implant rippling
Since you have rippling with saline breast implants, I would recommend converting to a silicone gel implant which has a lower incidence of rippling/wrinkling. You can also decrease the size of the implant slightly as you are relatively thin and this will help. Furthermore, you may need a synthetic skin (acellular dermal matrix) placed in between the implant and your tissue to help camoflauge the implant, this can be done with either Strattice or Alloderm. Hard to say exactly what you need without seeing you in person, but these changes should help.
Please consult with a board certified plastic surgeon for a comprehensive exam and review of your treatment options.
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.