What can be done to fix my implants? (Photo)

Question

Hello, I had a revision and I am still having problems with rippling and un evenness. I have 800cc silicone gel implants under the muscle. Everyone says if you use silicone and go under they won’t ripple. Well that is not the case with me and I don’t know why. Also how can I fix the unevenness. Does my right side have a capsule which is not allowing the implant to drop? It’s a completely different shape than my left one. Pleaee help!

Gary M. Horndeski, MD · Answer

800 cc implants are quite large, weigh almost 2 lbs. each and will descend inferiorly and laterally. I recommend you exchange your implants with smaller ones and at the same time do a circumareola lift to reposition the nipple-areola complex.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Sean T. Lille, MD · Answer

Ripples can occur with both saline or silicone. Silicone, however, produces less rippling compared to an equal volume in saline implants. The amount of tissue coverage is also important. If your skin and/or the muscle is thin (thickness of the muscle is important if the implant is placed below the muscle), rippling will become more apparent. Lastly, the bigger the implant, the more the surrounding soft tissue will be displaced by the implant and the more likely you will see the edges of the implant that ripple. In your case, I would significantly reduce the size of the implants and consider placing strattice where the muscle is not covering the implant. You may also want to use a more cohesive silicone implant that ripples less than the regular silicone gel implant. Hoped this helped…All the best!

Michelle Zweifler, MD · Answer

Yes, both silicone and saline implants can have rippling. With larger implants and less natural breast volume, the skin may be thin showing the implant edges and rippling. This may be improved with fat grafting and/or off-label internal mesh.

Connie Hiers, MD, FACS · Answer

First, your implants are much too large and heavy for your tissue and frame. they have stretched your own tissue which is now thin and lets the ripples show. You may have some capsule formation, but your lower implant is bottoming out from the heavy weight of the implants on your tissue. You need to go smaller.

Gregory Sexton, MD · Answer

When implants are under the muscle, we rarely see rippling at the cleavage line. You can get rippling under the implant or on the side where it’s not covered by muscle. Looking at your breasts it appears the pocket has been made too close to the midline, which puts the implant too close to the middle where it is not covered by muscle or breast tissue and that is probably why you’re seeing the ripples. You can tell it is too close to the mid line , seeing the nipples pointing out to the side. You really want your implant centered behind the nipple, not that far to the inside. Often the patient will ask for the implants to be closer and that’s when someone gets into trouble, if we put the implants too close, it makes the nipple point out and a good chance of getting ripples.

I have never examined you, but I can think of two options that may, I emphasize may, fix the problem. Option one would be to take the implants out, repair the capsule, leave them out for three months, allow things to heal, and then go back and put new implants in the same pocket now covered by muscle and breast with more distance between the implants. Number two, take the implants out , stitch the muscle back down where it belongs and make a new pocket on top of the muscle, using mentors boost implants, which are extra cohesive and less likely to ripple.

I think just trying to go in and repair the midline capsule, pulling it down and separating the implants without removing the implants or without making a new subglandular  pocket will probably fail.

Good luck, 
Greg Sexton, MD
Columbia, South Carolina

Darryl J. Blinski, MD · Answer

Based on only two posted photos, one which is a before, and after is the other only in person or virtual consult will allow better decision-making. It appears the one side does have a capsule that can be released by an open capsulotomy with fat crafting in the subdural plane under ultrasound guided injections if enough donor fats available in other areas of the body. Expect me to range from $8000-$12,000. Again, virtual consult is best.

Mats Hagstrom, MD (license on probation) · Answer

The outcome of breast augmentation surgery is usually based on three variables.
The first is the patient’s candidacy for the procedure in the first place.
The second is the choice of implants in regards to size shape and type.
The third is the surgeon ability to put the implant in the correct anatomic location.
In your case you have significant divergence of your breast. Your surgeon placed the breast significantly towards the midline in order to give you cleavage, but it’s not centered on the nipple because your breast sit laterally.
Anytime excessively large implants are selected the chance of undesirable side effect, complications and need for revision surgery will always go up.
Women who have breast divergence will have the divergence put on display with the projection of the implants.
If you’re having to rippling that high on your breast, then I’m guessing that part of the implant may not be covered by pectoralis muscle.
I’m guessing that in an attempt to place the implant as medial as possible and fit that big of an implant, the muscle may have been taken off. It’s origin along the ribs.
Silicon implants are less likely to ripple than saline.
All implants can ripple.
In your case, your outcome or issues related to your outcome can be traced back to all three of the above stated variables.
Your canIn your case, you’re outcome or issues related to your outcome can be traced back to all three of the above stated variables.
Your candidacy for breast augmentation was not ideal.
The choice of implant is excessive and the surgeons ability to put the implant in the correct anatomic location is slightly off.
Placing the implants more laterally Wood center them on the nipple, but not give you the cleavage.
Purposely placing the implants off center when women have breast divergence is not uncommon.
Divergence is a tricky thing and this should be discussed at length during in person consultations before scheduling surgery.
Best,
Mats Hagstrom MD

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