1 Week After Implant Revision and Right Breast has Started Rippling, What Should I Do?

I'm 27 years old and just got 350cc saline implant removed and replaced with 450cc silicone put in a week ago. A day after my surgery, my right breast started rippling. I never had this issue in my right breast with the saline. Both times were put under the muscle. I am a little sad b/c I feel like I paid all this money to get a rippling boob. What do u think is going on and what would u suggest?

Doctor Answers 7

Breast Implant Rippling?

Thank you for the question.

Unfortunately, it is not possible to get a precise advice/suggestions without direct examination.

Hopefully, a few general words regarding breast implant rippling may be helpful:

Palpability  and rippling of breast implants may be related to several factors. These include the amount of soft tissue and breast tissue coverage over the breast implants, the position of the breast implants (submuscular versus sub glandular), the type of implants (saline versus silicone), and the degree of overfilling of saline filled implants. Generally, weight loss will extension weight any rippling/palpability  of the implants.  Deflation of saline  implants will also increase the rippling/palpability of the implants.

Correction of the rippling may involve further surgery including implant pocket exchange if possible ( sub glandular to submuscular), implant exchange if possible (saline to silicone), and/or the use of allograft to provide an additional layer of tissue between the implant and the patient's skin. Patient weight gain (if possible) may also be helpful.

Best wishes.

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 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

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 119 reviews

Rippling of implants

Too bad you developed rippling at a week. This will probalby get worse with time. You may need more soft tissue coverag by putting it in a submuscular pocket if they are not already. Or else you  may need strattice to be added as another layer.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 23 reviews

Larger implants may make rippling worse

Because the tissues have to be stretched they will thin more with larger implants. The pectoral muscle only covers the upper and inner portion of the implant, so the rippling typically appears on the outside and bottom parts of the breast. The muscle does not provide support. Silicone implants do tend to ripple less than saline but as you know there are several factors involved.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 44 reviews

Rippling of breast one week after augmentation

This is very unfortunate, but it is difficult to give even general advise with the little information you provided (no height, weight or photos). I assume that you are "skinny"  and your tissues are thin and that is why you experience rippling. Going to larger implants to fix rippling is a falacy. Your tissues will continue to stretch and become thinner with further rippling. These concerns should've been discussed with your plastic surgeon (I assume you did see a board certified plastic surgeon), prior to surgery. Your options are either fat grafting around the implant in the rippled areas or another surgery with placement of tissue matrix to thicken the tissues and mask the rippling. The second option is significantly more expensive due to the cost of the tissue matrix. Good luck.

Rippling after implant exchange

Thank you for your question. Rippling can be seen when the surface of an implant shadows through the tissue, often found where the breast tissue coverage is thin. Some implant styles are more prone such as an overfilled saline implant. You went from saline to silicone, but also increased the size so it may stretch and thin the breast tissue a little more.  If you notice the rippling soon after surgery, I often recommend waiting until around the six month mark as your breasts may continue to change during that recovery period. I would follow up with your plastic surgeon to follow the progression of your healing and revisit any persistent rippling at a later time.

If the rippling persists and you want to keep the larger size, then one approach would be to add some thickness to the breast tissue. This can be done by fat grafting where fat is carefully layered between the skin and the implant. Another is to add a dermal matrix sheet between the breast and the implant where the rippling is visible to blunt the impression of the implant on the overlying skin.

Implant Rippling

I'm sure you are aware that rippling is not an uncommon event with saline implants.  The larger the implant in a thin skinned individual, the higher the risk of rippling.  This can at times be overcome by over-inflating the implant, but my preference is to switch to silicone implants which has a lower risk of rippling, and placing the implant in a sub-pectoral position.  More complicated and expensive options also exist, and your board-certified plastic surgeon can give you those with a consultation.  Best wishes!

Brian Howard, MD
Alpharetta Plastic Surgeon
4.5 out of 5 stars 19 reviews

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.