6 months post op, possible bottoming out and rippling? (photos)

From the photos you provided, it appears that your implants have not bottomed out.  I always tell my patients that an augmentation frequently magnifies existing breast asymmetry.  You are also very thin with very little natural breast tissue in the lower pole which can mean that rippling can be more evident even with silicone implants.  If the rippling is very bothersome, you might want to inquire about Sientra high fill silicone implants.  These implants are slightly overfilled to push out against the casing to reduce rippling.  Best of luck.

Unfortunately rippling  goes with the territory when you have little breast tissue and body fat.  You have a nice result and a revision does not seem warranted at this point.  But always bring your concerns to your surgeon.All the  best to you. 

Overall you have an excellent outcome;
your plastic surgeon did a great job with an overall natural, proportionate
look. Your photos do not demonstrate obvious rippling so it is hard to comment
on that. Generally speaking, your surgeon has minimized the occurrence of
rippling by using silicone gel implants in the sub-muscular plane. Other
options to help would be fat grafting to help thicken the breast tissue
coverage over the implant, or covert to form stable implants which are firmer
and ripple the least. Both are expensive and more surgery so you need to
re-consider carefully your overall satisfaction at this stage. Thank you for
sharing.

Without a physical examination it is difficult to address your concern. You have rippling which is palpable, but not visible on these photos. You do not have bottoming out. The rippling is secondary to thin tissue coverage over the implants. This can be improved in a couple of ways; either by fat grafting in the lower poles of the breasts (minimally invasive) or re-operation and placement of ADM like Strattice to add additional cover over the implant from the muscle edge to the inframmmary folds. See your surgeon or seek a second opinion from a board certified plastic surgeon. Good luck.

This can be a difficult problem. Your breast were a bit asymmetric before the surgery so my guess is the surgeon employed a dual plane technique with muscle release in the lower portion of the breast to give you a rounder fuller shape under the breast. If the skin in this area is a bit thin, then the implant will be more palpable. Unfortunately, surgery to correct this would require placing an internal "bra" made of acellular dermis (Strattice, Alloderm) or silk (Seri Scaffold) to support the implant internally and help take some of the pressure off your thin tissues. This would be quite an undertaking and you would need to weigh the pros and cons carefully with your board certified plastic surgeon before undergoing more surgery.

There are many
things going on. Looking at your pre-operative photos you had smaller breasts
with a tight skin envelope. So with larger implants your skin is now stretching
and certainly the lower half will stretch as well over time. You are not bottoming
out from what I can see, rather I see simple stretching that seems normal. With
respect to rippling. This depends on how thin your skin is and how thin your
breast tissue is. The muscle likely was partially released over the lower
breast to accommodate the implant. It is done so the implant will settle with
the breast. This is one layer of tissue that now is not between your breast and
the implant. So if you have thin skin, thin breast tissue and the muscle is
partially released you have a high likelihood of feeling the implant and seeing
rippling.

and your problems are simply a reflection of the quality of your overlying tissue. If you want to further attempt a reduction of rippling, you will have to consider shaped implants. But why go through the costs and potential risks when you really look good. Another thing I tell my patients when they are concerned about rippling... if your partner complains of it during intimacy, it shows a lot about your partner's character and I personally would not want to spend much time with someone like that.

Either return to your original surgeon for revisions if indicated. Or seek other only IN PERSON second opinions for revision....

In patients who start out with smaller breasts and less breast tissue, rippling, either palpable or visible, can be more likely to occur. You have excellent results. I would not recommend a revision. But, if your results still concern you, then it's best to bring this up with your plastic surgeon. Thanks for sharing your photos and concerns. Best wishes.