I switched from saline h.p under muscle 290cc filled to 310cc, to 350cc cohesive silicone grade 2-3(perthese sensitive) m.p. 350cc under muscle. This was to attempt to improve visible rippling in my left breast, and for a slightly larger look. I recently developed terrible rippling in my left breast worse than before, and my muscle edge looks like it's digging into the implant. My natural tissue is hanging oddly over the implant, plus they seem smaller! What can I do? I'm very upset.
3 Weeks After Revision Breast Augmentation and Depressed with Results
Doctor Answers (7)
Options for double bubble constricted tuberous breast deformity with bottoming out implant
Overall, it is my impresson that you began with a relative left breast constriction. Although symmetrical, your implant appears to have descended below your natural breast crease. In general, there is not alot that could have been done to prevent this and options include a dual plane approach with radial relaxing incisions and downsizing to a smaller diameter implant.
Rippling Often Present No Matter What Type Of Implant Used
One of the great myths out there is that the silicone implants, even the 410 ultacohesive implants, do not ripple. This is just a myth. No matter what the implant, it can show its edges if the tissues are too thin in that area. based on yoru photograph, it appears that you are very thin in the medial area, and could benefit form having some better tissue coverage. Sometimes that can be done with an internal capsule flap, while other times you need to use some biologic material, like Alloderm or strattice for reinforcement. That is really the only way to help decrease the rippling in that area. With regards to feeling like the breast is hanging off the implants, if it is a textured implant, the implants will not conform naturally to your breast tissue, giving the appearance that your natural tissue hangs off the implant. I would address these things with your surgeon and see what he/she has to say. I hope this helps.
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Unfortunately, it may be difficult for you to avoid rippling because you may not enough tissue coverage (too thin!) over the implant. Another possible cause, may be that your native breast may need to be detached from your muscle for a "dual plane" procedure.
Breasts and rippling
I am not sure which photos are pre or post. In some you have a double bubble. It is hard to see the rippling, but this can happen in thin patients with almost any implant.
Rippling breast implants
All implants ripple but some do more than others. The cohesive gel implants ripple less than others. The rippling is present even when you do not see it from the outside. In that case you have thick enough tissue between the outside world and the implant so you do not see rippling from the outside. Just looking at your photos without knowing exactly what was done, what your anatomical measurements are or what you looked like before it is hard to give you a specific definitive answer.
I assume the upper 2 photos are with the saline implants, the bottom 2 with the cohesive gel and that all surgery was performed via the breast crease. In both cases the implants appear to lie too low on the chest wall with downward displacment of the breast crease and the breast tissue/implants are not centered under the nipples. Most patients are fixated on implant and breast size which can become a problem if the surgeon gets pulled into that mode of thinking. You can have 2 implants of the same size but different side to side and back to front dimensions. Which one is chosen can have a dramatic effect on the end result. I suspect the side to side (diameter) dimensions of the implants used was too big for your baseline frame and breast size. That probably contributed to your problem. The question is how to fix it and I am sure 10 surgeons will give you 10 answers. I would think going to a smaller diameter implant and placing an alloderm like material in the left lower inner quadrant attached to the undersurface of the muscle (too increase effective tissue thickness in the area) is a reasonable way to go. Most cosmetic patients are reluctant to have alloderm or material like it placed because it is expensive.
Revision Breast Augmentation: Keys to Success
Revision breast surgery for rippling is very difficult to prevent from recurring. The rippling is usually not from the actual implant but more from the scar tissue that has formed around the implant and how much coverage you have on top of the implant. You are very thin and have little coverage over the implant with fairly large implants. The cohesive gels do form rippling and may have more problems with this, so recurrent rippling may be predictable. The animation deformity is likely from too much central muscle release and ironically is where you have the problems. A solution would be to interpose a sling of acellular dermal matrix in this area to help cover the implant, repair the muscle and support the implant. The downside is that these products are expensive, but in the right patient well worth it. You may also need some tightening of your lower breast skin. I hope this helps and good luck.
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.
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