Alloderm Vs Fat Grafting for Silicone Implant Rippling?

I'm 5'3", weigh 116 lbs and have 400 cc sub-muscular silicone implants. I went from a B to a D cup with the augmentation. The right breast is fine, however the left breast shows rippling in the cleavage. It's enough that I won't wear anything low cut. I realize my skin is too thin and I either need alloderm or fat grafting to fix the problem. Should I have one or both?

Doctor Answers 3

Rippling

Breast Implant Rippling most often occurs when there is insufficient soft tissue coverage due to little overlying body fat and breast tissue. Implants placed beneath the muscle help to minimize this phenomena but the lower and outside breast (as pectoralis muscle is no longer present), towards the cleavage where the muscle thins out or on top of the breast where breast tissue is often lacking are the most common places to see rippling. It is often accentuated with certain positions (e.g. bending over,or leaning). Most of the time, rippling is felt along the outer side of the breast and the inner side of the breast next to the cleavage. Breast implant waviness (rippling) that is felt but not noticeable to the eye is very common and should not be a concern. However, when rippling is visible, patients are often self-conscious about their appearance.
Factors that are associated with increased rippling include:
  • Traditional Saline implants (IDEAL® Saline implants less likely)
  • Textured implants
  • Large implants
  • Thin patients with low BMI
  • Implants placed above the muscle
  • Prior history of rippling
Factors which are less likely to have rippling include:
  • Heavier and larger breasted women
  • Using a highly cohesive form-stabile silicone implants (gummy bear)
  • Smooth implants
  • Smaller implants
  • Submuscular placement
Once rippling occurs it is very difficult to correct. Rippling can be minimized by placing a biologic fabrics (e.g. AlloDerm®, Strattice™, SERI®), submuscular conversion if implants are above the muscle, fat transfer, use of adjacent tissue (muscle or fascia) if available, and in persistent cases implant removal and fat transfer. Seek the care of the best board certified plastic surgeon possible with experience in breast revision surgery.

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Repairing ripples after gel augmentation

Ripples can be a vexing problem in one who is thin as you describe yourself.  Fat grafting is simple to camouflage the irregularities but do you have fat elsewhere that can be used and are you accepting of the risks?  Alloderm or Strattice could be placed in the area of concern but there is considerable risks and cost that would come with it.  Finally, you could consider converting to the textured anatomic cohesive gel implants but they lose the 'natural' movements of your current implants when you lay down.  Talk to your doctor about your options and pick what is best for you.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Strattice, Alloderm, or fat grafting for implant rippling

Thre are a number of things to consider when breast implants show rippling, including the very important question of whether the implants are of the appropriate diameter. In general, ripples will show where the tissues have thinned out. Strattice is my go-to option for that since it has better coverage than Alloderm, and is much more predictable than fat grafting for that application. Alloderm is most often used in breast reconstruction, where its more stretchy quality is beneficial with tissue expansion.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 45 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.