What Can I Do to Avoid Further Rippling of my Breast Implants? Does Exercise Effect Rippling? (photo)

Question

I am 4 months post op from having silicone breast implants placed under the muscle- 400cc (R) and 450cc (L). I was 34A pre-op and am now a 34C. After my swelling diminished I noticed 1 ripple in the cleavage of my breast- it looked like a thumbprint. What concerns me is that after I work out the existing ripple seems to deepen or new ripples appear. The next few days they will not be visible. Is it related to activity? How do I prevent any more permanent ripple damage to results of implants?

Larry S. Nichter, MD, MS, FACS · Answer

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 implantsLarge implantsThin patients with low BMIImplants placed above the musclePrior history of ripplingFactors which are less likely to have rippling include:Heavier and larger breasted womenUsing a highly cohesive form-stabile silicone implants (gummy bear)Smooth implantsSmaller implantsSubmuscular placementOnce 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.#rippling#breastaugmentation

Kenneth Hughes, MD · Answer

Fat grafting or a dermal matrix may be incorporated to decrease the appearance of rippling. Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast augmentation revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Thank you for your photographs. Usually silicone implants have less rippling. You must have thinner skin in that area. Exercise will not affect this. You may need to have a small amount of fat grafting in that area to cover the rippling.

	Dr. ES

Vincent N. Zubowicz, MD · Answer

There's really not much more you can do relative to the rippling. Fat injections are a possible solution but fairly aggressive. The implants are under the muscle which usually doesn't make a difference a silicone gel implants but they are there anyway. Exercise has no effect on rippling.

Darryl J. Blinski, MD · Answer

The easiest method of trying to correct ripples is adding fat grafts to the ripple areas. Otherwise replacement with NEW implant or ACD matrixes gets quite expensive.

Steven Wallach, MD · Answer

Rippling occurs because of a thin tissue coverage.  This can be improved by adding fat or strattice possibly.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures. Exercise does not directly affect rippling/ visibility of the breast implants. However, as you lose body fat, you may find that the extent of rippling/palpability of the breast implants increase.

	 The use of acellular dermal matrix may be very helpful and providing additional “coverage” between the breast implants and your skin. You may find the attached link helpful as you learn about options.

	 Best wishes.

Jeffrey Zwiren, MD · Answer

Exercise will have no effect on rippling. It is possible that the rippling would have been worse with saline filled implants. The more soft tissue over the implant the better. I have seen patients where the muscle was over dissected medial to achieve more cleavage thus lessening the degree of soft tissue coverage. Possible treatment would include fat injections or consider Strattice.

Kent V. Hasen, MD · Answer

Rippling is related to the amount of tissue (both breast and fatty tissue) that you have covering the implants as well as the type of implant. Rippling is worse in thin people with less breast tissue and more implant. Also, rippling is worse with saline and round gel implants. The newly FDA cleared 410 highly cohesive gel implants had less than 1% rate of rippling or wrinkling at 7 years in the pivotal study. Exercise really doesn't affect the rippling, unless you are becoming more lean with less body fat, then the rippling would worsen since again there is less tissue covering the implant. It is still too early in the post-operative period to really determine if something needs to be done to address it. Options would be to add fat via fat transfer or add acellular dermal graft like Strattice to help camouflage the implant shell versus changing the implant to a highly cohesive gel like the Natrell1 410.

Lisa M. DiFrancesco, MD · Answer

Thank you for your question. Exercise does not have an effect on implants. Rippling is a problem usually caused by a lack of breast tissue over the implant mading the implant visible. It is too early in your post op for additional surgery but ADM or fat may be a solution.

What Can I Do to Avoid Further Rippling of my Breast Implants? Does Exercise Effect Rippling? (photo)

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