I have awful rippling even with Naterelle 410 FF style and subpectoral placement. (photos)

I'm very unhappy with my recent revision. My doctor is fabulous, it's not his fault at all, he corrected my asymmetry but I'm petite & even w cohesive gel I have extensive rippling. I wish I would've went with rounds and use alloderm or Strattice. I feel stuck now bc although symmetry is greatly improved I have visible rippling anteriomedially and laterally. I'm too small to fat graft and I don't know if strattice can be placed at this point or if I may as well totally revise and go w rounds.

Doctor Answers 5

Wrinkling and Rippling

Super tough problem.  I have about 800 - 410 patients and still see this problem sometimes.  The challenge is you have the implant with the least amount of inherent wrinkling and stays in position well thus limiting traction rippling but you can still see it where you are so thin...Fat grafting is the best current solution with support but the problem is that patients who need fat the most don't have it!  And I know you guys will not eat more cheeseburgers!  So what I tell my patients is to be patient.  We are working on some off the shelf products that will truly thicken tissue to his implant irregularities and future generation devices probably a year from the US market will have significantly less rippling.


Your result is really - really good---I tell my patients to wait until we have some better solutions.  I use a lot of Strattice and Hi fill implants and that's not the answer either.  Better but never gone.


Hang in there.

Best


Dr Bengtson


Grand Rapids Plastic Surgeon
4.8 out of 5 stars 44 reviews

Strattice

Unfortunately, with his thin as you appear, all breast implants will have the potential for some wrinkling. Only a maximally overfilled saline implant which would look like a round ball would not wrinkle. with a piece of a thick ADM  between you and the implant some of the rippling can be ameliorated. Congratulations on your surgery and good luck for a final outcome that you will be happy with.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

Rippling

                                                                                                                                                                                                      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… SHOW MORE
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 implants
  • Large implants
  • Thin patients with low BMI
  • Implants placed above the muscle
  • Prior history of rippling
Factors which are less likely to have rippling include:
  • Heavier and larger breasted women
  • Using a highly cohesive form-stabile silicone implants (gummy bear)
  • Smooth implants
  • Smaller implants
  • Submuscular placement
Once 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

Strattice for better coverage with rippling

Yes you can have Strattice with 410 cohesive gel implants. Although there is some risk of implant rotation because the portion of the implant covered by the Strattice will not adhere to the textured implant, with a mature capsule it should be a minimal risk. 

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 47 reviews

I have awful rippling even with Naterelle 410 FF style and subpectoral placement.

I am sorry to hear about your concerns after revisionary breast surgery. Although definitive advice would require in-person evaluation, it sounds like you are thinking along the right lines: the use of additional "coverage" material such as acellular dermal matrix will likely be necessary to improve your outcome when it comes to breast implant rippling/palpability. You may find the attached link, dedicated to this type of revisionary breast surgery helpful to you as you learn more.   Best wishes.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.