I've had 3 surgeries, 1 saline, 2 coh gel. Saline didn't look natural. Gel showed rippling. Should I try again? (photo)

I am a 34A. 350cc sal didn't have a smooth transition from my chest to the implant. I have a wide breast bone. Another Dr said coh gel would look more natural and I'd get more cleavage. A few days after surgery I noticed rippling. The Dr prescribed me an asthma med. thinking it would soften the tissue around the implant to smooth rippling. I have very thin skin. That didn't work. We placed the same implant under the muscle. That didn't help. I had them removed. Should I consider fat injections?

Doctor Answers 9


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A good rule of thumb is that if you can see your ribs pre-operatively then you will likely be able to see the underlying implant as it sits on top of the chest wall (when placed sub muscular). Rippling is not the issue, coverage is the issue. Thin skin overlying an implant will make the implant more visible (and the inherent rippling as well).

Thin tissues can addressed via fat transfer or use of acellular dermal matrix to better conceal the implant beneath your native tissues.

As always, consult with your board certified plastic surgeon to determine a treatment plan which works for you. 

Kissimmee Plastic Surgeon
5.0 out of 5 stars 13 reviews

3 surgeries, still rippling

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Hello and thank you for your question and picture.  I agree with your assessment of your breast bone width.  So for starters an anatomically shaped (tear drop) implant may provide a more natural looking augmentation for you than a round implant.  To address the rippling, you may want to consider using an acellular dermal matrix around the implant or fat grafting to thicken your tissue and better hide the implant . 
The most important thing for you to do is consult with an experienced plastic surgeon who you feel comfortable can deliver the results you desire. 

Best of luck to you,

Ruth Celestin, MD

Ruth Celestin, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 33 reviews

Treatment for rippling after breast augmentation

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Thanks for sharing your question.

Much depends on your exam and where the concern you have is.  In many cases revision breast augmentation with a tissue matrix like alloderm can provide additional thickness and improve the appearance of rippling.  Fat transfer can be considered, and should be performed by surgeons with extensive experience in this procedure.

Steven M. Camp, MD
Fort Worth Plastic Surgeon
4.9 out of 5 stars 120 reviews

I've had 3 surgeries, 1 saline, 2 coh gel. Saline didn't look natural. Gel showed rippling. Should I try again?

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your posted photo appears as a pre op??? Please add additional photos. But very unusual for ripples in silicones/cohesives... 

Rippling and breast implants

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You have a few options.  In order to remove the possibility of rippling, do not have an implant and have some fat transfers to increase your volume.  If you are looking for an augmented "look" you will want to consider some combination of fat transfer to thicken the soft tissues above the implant or acellular dermis mesh to thicken the soft tissues.  An anatomically shaped implant will also help more than a round one.

Samer W. Cabbabe, MD, FACS
Saint Louis Plastic Surgeon


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Rippling will occur as a result of a thin soft tissue coverage.  Fat injection can soften this and so can strattice a acellular dermal matrix.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Rippling after Breast Implants

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Rippling can occur from thinness around the implant. As you have experienced, it can occur with both saline and silicone  implants. If your tissues are thin, and your bones show, then your implant can show too. To minimize rippling, adding coverage is essential. If the sub muscular pocket did not help, then adding fat may be an option, provided you have a donor site for liposuction. Weight gain also helps, but for most women, that is not an ideal option. Smaller implants also cause less tissue stretch and therefore may ripple less. I would recommend additional consultations with board certified plastic surgeons to determine the best surgical plan.

Rippling in implants

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There are two types of rippling, vertical striations and side rippling.  The more tissue you have the less chance for rippling.  The more filled your implant is the less chance for vertical rippling.  The larger you go the more chance for rippling.  Finally under the muscle would significantly reduce vertical rippling as there is more tissue to cover the upper pole of the breast.  You are very thin so right away I would never place implants above the muscle.  Your nipples are also far apart.  So if you want decent cleavage you may chose a slightly wider implant which will improve cleavage, but try to stay within 300 cc.  I would recommend the Mentor MP+ type of smooth silicone implant as they are the most filled compared to Natrelle or Sientra.  I would also try to stay away from textured silicone implants as they ripple more compared to their smooth counterparts.  If the MP+ still ripples then I would try adding fat to the areas you are rippling in.   The other choice is to gain a few pounds, as a little bit of body fat goes a long way to reduce rippling in implants. 

Benjamin Chu, MD, FACS
Honolulu Plastic Surgeon
4.8 out of 5 stars 106 reviews

Fat grafting

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Fat grafting is an option but it is very technique dependent so you should find a board certified plastic surgeon who has significant experience with this procedure.

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.