Why do I have SEVERE rippling after breast revision from saline to silicone?

My guess is that your implants are above the muscle.  You probably had mild capsuar contracture around your subglandular saline implants which often occurs.  This tight capsule probably masked the ripples.  Your surgeon most likely performed a complete capsulectomy when exchanging your implants.  This loosened up the pocket now set you up for ripples, even with silicone implants due to your thin tissues.  You should be converted to the submuscular position.Good luck,Ary Krau MD FACS

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

I am going to assume that the implants are about them also. If this is the case then they need to be placed below muscle. If there still some question about the thinness of the tissue you may need a dermal matrix placed internally to provide more coverage.

Silicone gel implants have less problem the surface irregularities and saline. They do not guarantee against it however. If you are losing confidence in your surgeon there's nothing wrong with getting a second opinion.

Rippling happens with thin tissues.  Are they below the muscle?  Sometimes Strattice is a good choice to add another layer of soft tissue coverage over the implant.  Sometimes fat injection may help as well.  Best to be seen in person. 

Thanks for your question.  If you had a capsulectomy, a removal of the capsule, in addition to the removal of the implant this may have further thinned your skin.  It is also possible that the implant flipped 180 degrees causing the unusual shape.  Ask your plastic surgeon for his recommendations or seek a second opinion.  

I am sorry to hear about your relationship with your plastic surgeon; he/she will always be your best resource for accurate information given that he/he knows exactly what was done during your operation and has the benefit of in-person physical examination. If you have not lost weight, then it is possible that during your revisionary breast surgery, some breast implant capsule removal and/or adjustment was performed.  If so, this may explain why you are feeling the current breast implants more so than you did before. Also, some patients will find that silicone gel breast implant rippling/palpability may be more bothersome than what they experience with saline breast implants, if they were overfilled. Again, just some thoughts; your plastic surgeon will be your best resource. Hopefully, you will be able to improve your relationship/trust.  If revisionary breast surgery does become a consideration, the use of acellular dermal matrix may be helpful. Best wishes.