New Silicone implants that have rippling and sagging... HELP!! (photos)

Thank you for your question.  The reason you have been told different things by different surgeons is that you have a challenging problem and there is no one right answer.  Anything that is done to attempt to correct this is going have pros and cons as well as tradeoffs.  You will probably get lots if other opinions on this forum but it is difficult to give you advice without more information and the ability to do a physical examination.  Was this a straight implant exchange or was there more involved?  Were the original implants over or under the muscle?  Was there any capsular contracture that was addressed at the time of surgery? What I can tell you is that because of your lean build and the fact that it looks like you don't have very much to cover your implants other than skin you are a setup for visible rippling even with silicone gel.  Your implants have a diameter of 14 cm.  If the base width of your breasts is less than that then when you are upright or leaning forward rippling will be more likely.  If this is the case and a higher profile implant had been used to better match you'd base width then you may not have had as much rippling but there would have been less upper pole volume and the implants would shift more to the side when you lie down. Correction of this will involve some combination of breast lift, exchange of implants to smaller higher profile or shaped, the use of ADM (like Strattice) for extra coverage and support of implant, creation of a new pocket between the existing scar capsule and the muscle, relocation to over the muscle and possibly even other options.  Each of these possibilties has its own unique risks and tradeoffs that will need to be discussed with your surgeon. If the surgeons you have seen are all experienced plastic surgeons certified by The American Boatd of Plastic Surgery then you will have to weigh out the different options and choose one that works the best for you.  You should ask to see examples of similar cases that they have done in the past to get an idea of what they hopefully can accomplish for you. Take your time and don't rush into anything.  

Implant #rippling is unlikely a serious issue as much as it is #esthetic. If you are very thin or lean, any type of #implant can display some #wrinkling. An ultrasound or #MRI can reveal otherwise. Such as if it's a silicone implant which is leaking. Nevertheless, the implant or both can be revised if you choose. 
However, #positioning under the muscle may help.  Silicone implants do better than saline in this case. Also, adding a mesh (i.e. #ADM or similar) can help. Smaller implants, skin #tightening and #capsulectomy may also treat  #rippling or #wrinkling. Be sure to select a plastic surgeon who is #board-certified and has a great deal of experience with breast #augmentation and the incision type, #implant placement, and implant type. Plastic surgeons who have specialized in breast surgery and cosmetic surgery are suitable to perform your breast procedure. Aside from checking board-certification, it is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.

I am sorry to hear about your disappointment after breast surgery. Although the best advice would necessitate in person consultation, it is likely that you will benefit from  additional revisionary breast surgery at some point. In my opinion, this operation will likely involve some combination of breast lifting, capsulorraphy surgery, the use of acellular dermal matrix, and breast re-augmentation. These types of operations do require some expertise and experience; select your plastic surgeon carefully. Ask to see lots of examples of his/her work helping patients with revisionary breast surgery; it will also be important to learn about the pros/cons associated with additional surgery and to achieve a sense of realistic  expectations when it comes to outcome. You may find the attached link helpful to you as you learn more about options. Best wishes.

Rippling is a terrible problem after breast augmentation and occurs for a variety of reasons. It is a challenging problem and can be corrected in a variety of ways, and this is likely why you have got different recommendations from different surgeons.In addition to rippling, you have complaints that you are both too big and too droopy. Addressing these issues along with improving rippling can be complicated, so it is good that you take your time and do some research before having a revision surgery. Be sure that you see plastic surgeons certified by the American Board of Plastic Surgery.If you feel too big, then certainly you need smaller implants. If you feel too droopy then you may need a lift, and if you have rippling, you can combine certain techniques together with an implant size change and lift to create the best results.Rippling can be attributed to various things:1) Thin breast tissue/skin2) An implant with a liquid filling3) An implant that is the wrong size for the breast pocket - too big or too smallLooking at each of these issues that can lead to rippling one at a time:1) Thin breast tissue skinFat transfer or autologous fat grating can thicken the tissue to camouflage rippling, but you mush have some good fat deposits in another part of your body to get the fat from. This technique alone may mask the rippling, but will only add to the overall size of your breastsThe tissue can be thickened with addition of a tissue matrix - Alloderm (human skin) and Strattice (pig skin) have been used for these purposes. They are both collagen matrixes with all the cells removed, and they become a part of you as the body grows into them. This can thicken tissue to mask rippling.2) An implant with a liquid fillingImplants are ALL made from a silicone shell, but the contents vary greatly. In general, the more liquid the filling of an implant, the more the risk of rippling. Saline implants ripple the most. Next on the list are round silicone gel implants made from a 4th generation silicone gel (Alllergan and Mentor round silicone implants). Next are round silicone gel implants made from a 5th generation slightly firmer silicone gel (Sientra). Next on the list are the anatomically shaped tear drop shaped so called "gummy bear" implants which are all made from a highly cohesive firm type of 5th generation silicone gel (all three implant companies make these Sientra, Allergan and Mentor). Allergan's 410 anatomically shaped silicone implant is the firmest and therefore, may have the lowest risk of rippling. In general, the firmer the implant, the less likely you are to have rippling, the tradeoff is that they have a firmer feel. The other consideration is a nuance that plastic surgeons take into consideration is the "fill of the implant" how much silicone there is in an implant relative to what the shell can hold - some companies have implants that are under filled to a varying amount and this may contribute to rippling.3) An implant that is the wrong size for the breast pocketIf an implant is way too big for your breast size, it may fold on itself to create rippling - this can be treated by decreasing the size of the implant. In a similar sense, if the implant is way too small for your breast size, it make be loose and wrinkle on itself - and this can be treated by tightening the implant pocket with the use of a tissue matrix to hold it in a smaller more perfect space.Putting all of these things together: to decrease rippling and decrease drooping in size, you may consider choosing smaller implants made from a firmer gel - especially the anatomically shaped highly cohesive gummy bear type implant. A breast lift will help to decrease the extra skin, and use of a tissue matrix such as Strattice may help hold a smaller implant inside a smaller supported pocket. This will keep a nice perfect pocket around a smaller implant with a low risk of rippling . . . in a way that gives you a very long lasting result.Take your time and talk to several surgeons about which of these factors will help you get what you are looking for. Weigh the pluses and minuses of each of these factors to ensure that your revision surgery gives you the most ideal result.

Hi natomeara--I'm sorry to hear you are having trouble with your revision!  You identified the contributing factors to the problem in your post above. Your thin skin, lack of breast tissue, and large implants contribute to the problem.  The fact that your old implant likely thinned the overlying tissues doesn't help either. Also, when implants are changed, sometimes scar tissue or capsule is removed, which is beneficial in some ways, but thins your tissue coverage over the implant.  Finally, the rippling is an implant-specific problem, and is present with most devices. Your thin tissues just don't hide it well.  Luckily plastic surgeons have some tools to address this. Fat grafting or acellular dermis can thicken the tissues and disguise the rippling. A change to a newly-available cohesive gel implant helps, since these devices don't ripple or ripple to a lesser degree.  Ask your surgeon. In the meantime a supportive bra may lessen this rippling in the upper pole.

Thank you for the photos and I am sorry to hear you are again rippling.  From the photos it would appear that you would benefit from a lift, a pocket revision with a protein matrix and switching to a Sientra textured round or shaped implant that does not ripple but clearly a full examination is neededDr Corbin

It’s
really frustrating to find that a revision surgery hasn’t turned out as you’d
hoped. I suspect the reason you’ve gotten so many different opinions on the
best way to approach your treatment is because there may be multiple issues
going on. For the rippling issue, you might look into gummy bear implants (form
stable silicone), as these are the best option to prevent visible wrinkles. The
fact that you had little breast tissue prior to your first augmentation—and
that’s probably thinned quite a bit in the years since then—is most likely why
you can see the implant ripples, and also why your new implants have fallen. I
think you can see very nice results if you go to a breast implant revision
specialist, and combine a breast lift with your new implants.

Ugh.  Sorry you are struggling with this issue.  Dr. Pousti's response is right on.  Do not be tempted to short cut his approach as you need the extra support and coverage.  You MUST find a physician experienced in this type of reconstructive breast surgery to offer you the best chance of success.  Good luck.

I'm very sorry to hear of your disappointment.At this stage a combination of breast lift, replacement with textured breast implants wrapped with acellular dermis is likely your best option.If rippling persists fat injection can be used to camouflage the ripples.  Please see and experienced board certified plastic surgeon.For more information on revision of breast implants please see the following link: