For implant rippling, how much improvement could I expect switching from SSM to SCM? (Photos)

Question

I’m 44, lean and athletic and underwent an augmentation (OTM/subfascial) with lift 15 months ago. I currently have Inspira SSM, SoftTouch Moderate 330 cc implants and like the size on my frame but have rippling and implant show due to low body fat and tissue. I’m considering switching to Inspira SCM, Cohesive Moderate 330 cc implants in an implant exchange. How much improvement could I see through making the switch? Is pocket tightening with a swap indicated? I’ve asked about fat grafting, and was told I don’t have anywhere to harvest the fat from since I’m so lean. Are there other options you’d consider? I'm not interested in under the muscle placement because of animation deformity.

Gerald Minniti, MD, FACS · Answer

You are a tough one, but I understand if you don't want a subpectoral placement. 
I have found fat grafts works, but you'll need about 50 to 100 cc per breast, and I don't think that's happening. Sometimes folks like you actually have something to harvest in the inner thigh or buttocks. If not, Alloclae is an expensive alternative, though. Also, I would switch to Motiva Round implants; they are filled more and have a more cohesive gel, like Inspira cohesive, but not as rubbery.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  I have been in practice for over 30 years and revisionary breast surgery is a large portion of my practice. Your issue is very common.  I have found that switching to a higher profile implant is not very effective in minimizing your wrinkling.  I have tried fat transplantation many times, and that has not helped.  The only option you have is to place the implants under the muscle.  This is very effective at reducing or even eliminating the wrinkling.  Best wishes to you.

Gregory T. Lynam, MD · Answer

Preoperative photos may help but likely you need to consider a more cohesive implant that wrinkles less but still may wrinkle some or go under the muscle. You can use AlloClae which is cadaver fat but expensive and may not be worth the cost. The least $ is trying a Motiva more cohesive implant. Going under the muscle is the routine recommendation. 
Good Luck

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. I would say that without having seen your pre-op photos, your outcome is pretty reasonable and as can be expected. It is all about implant coverage. The more you cover the implant, the less it looks like an implant, the less coverage on the implant, the more you are going to see. The first issue is pocket placement - under the muscle is going to cover the implant more in that area but if that pocket is a "no-go" to you because of animation deformity, then it is what it is, you are accepting higher implant visibility to avoid the animation deformity. In medicine, like in life, a lot of decisions are a compromise, no one answer with all good things and no downside. Besides a pocket exchange, you have to consider things that will thicken or augment the skin envelope over the implant. Fat grafting is the obvious one but for patients with minimal fat to donate, there is now an off-the-shelf fat matrix called Alloclae which is an excellent (albeit very costly) option for someone like you. If you are considering moving from Soft Touch to Cohesive, that might help a little bit but will not eliminate the problem all together. Have your surgeon show you those two implants side by side and see if you can appreciate the difference. Marketing from Allergan quotes the Soft Touch as having 91% upper pole volume retention and the Cohesive having 97% upper pole retention. So you have to answer whether a 6% improvement is worth going back to surgery. In addition, if you are going back to surgery, you can consider placement of acellular dermal matrix (ADM) such as Alloderm or Strattice along that portion of the breast. This creates another layer of implant coverage that can disguise the underlying implant. Lots of options here, lots to discuss with your board certified plastic surgeon. Best of luck!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

For implant rippling, how much improvement could I expect switching from SSM to SCM? (Photos)

Answers (4)

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