Breast Implant Rippling 6 Weeks Post Op?

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

The risk of visible rippling increases:in women with less of their own natural breast tissuewith saline implants placed In the subglandular position (under breast tissue and over muscle)with larger implantshowever reputable surgeons apply techniques that minimize the risk of rippling. For example, a woman with less of her own breast tissue may decrease the visibility of rippling by opting to place the implants in the submuscular/dual plane position. However, this depends on the surgeon. You may want to discuss your concerns with your surgeon. Best of luck.

Hi! Thank you for your question,


I am Dr. Speron, a proud member of both the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgeons (ASAPS).  I am also certified with the American Board of Plastic Surgery.


Rippling with implants is a common issue. It is usually seen in thinner women without much natural breast tissue. Overfilling can help counter this effect. There are solutions for rippling, although they are all surgical. You’ve mentioned that your plastic surgeon had placed the implants Subglandular (over the muscle). Since you have minimal tissue to cover the implant, I suggest that you discuss with your plastic surgeon about performing a revision surgery and placing the implants Submuscular (under the muscle), this will help as the muscle normally covers around two-thirds of the implant. This will also lower risk of visible rippling.  An option is fat grafting to add tissue volume. Going smaller may help as well.


I generally ask patients to wait at least three months before undergoing any sort of revision surgery.  You want the tissues to heal up and become as close to 100% strength as possible before re-injuring them.
 

I have provided a link below for additional information and before and after pictures. If you have any further questions, please feel free to call us at 847.696.9900.


Best of luck and have a great day!
Regards,
Dr. Speron

Rippling after subglandular implantation in a thin patient is a known side effect of this procedure.  It appears from your post that the issue did come up during your consultation with your doctor.  Have a frank conversation with him or her and discuss potentially moving the implant to the submuscular position.  All the best.

Sorry to hear that. It certainly sounds like it may have been better to place your implants under the pectoralis muscles to give extra thickness cover over the inner and upper part of your impants. Speak to your surgeon at your review about your concerns.

You are absolutely not overreacting. Implants positioned over the muscle have a greater risk for palpability and rippling. Furthermore, implants that have a textured or rough surface are also at greater risk of palpability and rippling  Finally, implants that are of larger size particularly when placed over muscle in persons with thinner skin can absolutely expect this occurrence  So I would call into question the planning of your procedure.

Silicone implants that are cohesive gel can still have rippling in the thin patient.  The implants are 84% filled so they will move more naturally and not be a hard bump.  Under the muscle is usually a better choice but I'm sure that was part of your pre-op discussion.  Choices you have are to now move them to the submuscular pocket, try the Mentor Ultra-High implants that are about 95% filled (so less rippling) or place the Allergan 410 implant in a new pocket.  This would need to be a discussion with your plastic surgeon and what may be best for you.  Good Luck.

Well it's hard to say whether you should have gone under vs. over without before or after pictures. I do try to put implants under the muscle when possible to avoid this very thing. It is still very soon after surgery, so be patient. Meet with your surgeon and get their thoughts on the rippling. You can always layer fat over the area that has ripples to cover it. 

No you are not overreacting.  In thin patients rippling can occur even if going under the muscle but it is much less likely.  If I were your surgeon I would convert you to submuscular.  The only other option is fat grafting to the breast.

When you choose to go over the muscle, you are more likely to have implant rippling even with silicone implants. This would be particularly true in small and very thin-skinned women with little breast tissue. This is the trade-off for having a quicker and less painful recovery. For many women this is an unavoidable problem that needs to be considered before surgery when choosing implant location.