Will I have rippling with a 200cc saline implant? (Photo)

Question

34yo, no kids, 5'5", 140lbs with almost zero breast tissue. Hoping to get a small implant to give me some more shape. I had larger silicone implants in the past with an unknown rupture for potentially several years that I believe made me very unwell so my PS has suggested saline this time to avoid having an unknown rupture again. I have very little tissue, will 200cc saline implants show rippling on me?

Gerald Minniti, MD, FACS · Answer

More women with SSBI have saline implants than silicone gel implants. The reason why women who believe their implants are causing illness have saline implant more often than silicone gel is because they were psychologically prone to thinking this in the first place; studies have shown that the only statistical difference in women with 'BII' and those without are a prior self-reported history of anxiety disorder, health anxiety disorder, or a preference for getting medical information from the internet over a physician. Your silicone gel implants did not cause your perceived symptoms. There have been many studies showing there is no putative agent (20 different heavy metals, silicone, bacteria, bacterial endotoxins, and immune system cytokines) for causing this phenomenon and that removing the capsule has no additional benefit from removing the implant in women who believe their implants are causing harm. Trust science and get silicone gel implants, preferably Motiva implants.

Maryam Zamani (Saheb-Al-Zamani), MD · Answer

For patients with minimal breast tissue and low BMI, silicone gel implants (aka gummy bear implants) are best as they have significantly less risk of rippling while providing augmentation and good shape to the breasts. To monitor for silicone implant "silent" ruptures (so called as newer generation silicone tends to stay in place like a gummy bear even with a small rupture and generally not cause symptoms), the FDA recommends ultrasound imaging starting at 5-6 years post implant and every 2-3 years afterwards. Of course, if you experience any symptoms or changes to your breasts, you are recommended to have imaging outside of these guidelines. If your preference is to still proceed with saline implants, fat grafting to the breasts can be simultaneously performed to thicken the tissues and minimize the risk of rippling.
Best,
Dr. Zamani

Gary M. Horndeski, MD · Answer

Your chest wall is quite thin and you will not be able to have implants in front of the muscle. You will have to place the implants behind the muscle to conceal them. Placed behind the muscle, there will be less visible rippling. An alternative to consider, rather than just implants, is fat transfers. You are very thin but usually we can obtain fat from the legs and thicken up the tissue above the nipple-areola complex and adding more volume there will help hide any ripples that may appear.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Sean Fisher, MD · Answer

Saline implants do tend to have more issues with rippling than there silicone counterparts. As you have pointed out, this can be more apparent in patients who have very little breast tissue. Choosing a Duel- plane allowing for implant coverage with pectoralis muscle can help this to some degree. Additionally, you could consider adding fat grafting in addition to the augmentation to help further camouflage the implant. 
Sean Fisher Aesthetic Plastic Surgeon

Connie Hiers, MD, FACS · Answer

All saline implants may ripple, but staying with your selected size and placing them behind the muscle will give you a better coverage. Mesh could be added to help decrease the ripples.

Ali Arnaout, MBChB, FRCS(Plast) · Answer

Saline implants do have a higher risk of rippling, especially in patients with minimal breast tissue, like yourself. This is because the saline inside is more fluid and can create visible folds, particularly when there is little natural tissue to cover the implant. However, implant fill can influence this: underfilled saline implants are more prone to rippling, whereas fully filled or slightly overfilled saline implants reduce this risk.
At our clinic, we use Motiva implants (FDA approved) , which are silicone-based and known for their 100% fill ratio. They offer a very low risk of rippling, capsular contracture, and low rupture due to their advanced design and cohesive gel structure. However, since you’ve had concerns about a previous silicone implant rupture that went unnoticed, I understand why saline implants are being recommended for peace of mind.
With very little breast tissue and opting for a small 200cc saline implant, rippling is a possibility, especially if the implant is placed above the muscle. To minimize this risk, placing the implant under the muscle (submuscular) or choosing a different implant type may be options to consider. 
Your surgeon can discuss which placement or technique would work best for you to reduce visible rippling.

Mats Hagstrom, MD (license on probation) · Answer

I recommend you rely exclusively on in person consultations.
From your description, it is uncertain if you currently have implants?
If you’ve had implants removed, then re-augmenting is going to be challenging.
I generally do not recommend patients have their implants removed without replacement if they have any interest in maintaining implant augmentation.
If you’ve had your implants removed, then there’s going to be scar tissue that may make augmenting challenging.
Rippling may be an issue and scar tissue causing deformity may be an issue as well.
Follow up with your plastic surgeon or schedule in person second opinion consultations.
 Best,
Mats Hagstrom MD

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