BA 3 years ago with 450cc cohesive silicone gel over the muscle with severe rippling, bottoming out and uneven nipples (Photo)
Doctor Answers 10
Breast augmentation revision
Thank you for your clinical post and sorry to hear of the progression of your post-implantation aesthetic appearance. The one side of your breast augment has indeed bottomed out and being in the subglandular plane rippling is quite noticeable on the upper and upper medial pole. There is definitely pseudoglandular ptosis on that side and on the contralateral side there has been very little bottoming out with a nice chest-breast junctional take-off.
I thinking having another discussion with your surgeon and discussing maintaining this particular volume and changing profile or decreasing the implant slightly will have less significance than putting this implant in the submuscular plane and providing inframammary fixation. Inframammary fixation will help stabilize the lower pole using a low dual plane technique will likely minimize the risk of rippling post-operatively.
I think on the non-descended side you have a nice result. The left side has bottomed out. There is pseudoglandular ptosis with elevation of the nipple areolar complex. All of these should be greatly improved with enhancement revision surgery and I think you’ll end up with a nice result.
Keep in close communication with your operating surgeon and best of luck
R. Stephen Mulholland, M.D.
Certified Plastic Surgeon
Rippling and bottoming out 3 years after subglandular cohesive gel
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BA 3 years ago with 450cc cohesive silicone gel over the muscle with severe rippling, bottoming out and uneven nipples
The second issue is the thinness of your tissue which contributed to the first problem and also is the reason for the wrinkling and palpability that you have now. Changing to a different volume implant and/or higher profile doesn't help very much with this issue. The options for improving this include using a gel implant with a higher viscosity (meaning a thicker gel) like the firmer gel used in the "gummy bear" or highly cohesive gel implants. These implants are stiffer feeling, but hold their shape and don't wrinkle as much. Your surgeon can also wrap the implant with an absorbable mesh or ADM product which your body reabsorbs over time as it lays down a layer of your own tissue in its place which thickens the tissue. The third option would be to do some fat grafting to your breast in the areas of the wrinkling. This may be best to do at a follow-up procedure once you have healed from the initial revision. Good luck.
Breast augmentation Revision
Thank you for your question and photos.
I recommend that you focus more on the correction of the pocket/asymmetry than the size of implant. A range of 20-40 cc size difference is relatively small. Your Plastic Surgeon will be able to recommend on that they feel is the best fit, size & shape for you based on your measurements. A slightly firmer, high or full projection implant placed under the muscle could help reduce the appearance of rippling and capsulorraphy with strong reinforcement should address the bottoming out.
Seek a second opinion in person if you are uncomfortable with the plan.
All the best
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