Deep Indentations After Breast Augmentation? (photo)

I had breast implants in 1991 and after 21 years of enjoying them with no problems they have to be exchanged because rupture after a mammogram. After surgery I noticied these terrible deep indentations in my breast, I talked to the surgeon, he said there was nothing he could do about it. Went to another surgeon who placed different implants and now the same thing is happening. What's the problem? Will bigger implants will take care of it? I am desperate and sad, need all the advice possible. Tx

Doctor Answers 8

Deep Indentations After Breast Augmentation?

 I am sorry to hear about the complications you have experienced. Your disappointment ls certainly understandable.

It is possible that the breast implant have moved from behind the muscle but it is also possible that the previous revisionary operations have left you with very little soft tissue coverage.

Unfortunately, I do not think that your situation will improve without additional surgery. Exactly what operation you should undergo will depend on your past surgical history, current physical examination, and goals. In my practice, I would likely offer you the use of large segments of acellular dermal matrix to be placed between your breast implants and overlying skin tissues. Of course, if the breast implants have moved outside of the pectorals major muscle coverage area, re augmentation in the sub muscular position will be helpful.

You may find the attached link, dedicated to breast implant rippling/palpability concerns specifically, helpful to you as you learn more. Best wishes.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Rippling From Lack of Support

Rippling can happen when your breast does not have enough tissue to support it. Since you need implant support, it would be a good idea to get them under the muscle. You could also switch from saline to silicone, which would greatly help as well. As far as correcting the groves, you could try a fat transfer or a breast lift may help as well.

Jimmy S. Firouz, MD, FACS
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 18 reviews

Deep Indentations After #BreastAugmentation? (photo) ANS:

My guess is that you have above the muscle implants and very very thin tissue. It looks like to me that you have what we call "traction" rippling and can happen with any type of implant and even in some women without implants. You have no support of your skin or breast tissue when I assume your capsule was removed from the rupture and now have an implant that is pulling on your skin from gravity. I would probably recommend an implant exchange to below the muscle for coverage and support and then a lift on top of that to bring your loose tissue up.

John J. Corey, MD
Phoenix Plastic Surgeon
4.6 out of 5 stars 44 reviews

There is Hope

saline implants wrinkle more than silicone. they are prone to scalloping (wavy ripples along the circumference). they are usually placed under the muscle to avoid ripples in the cleavage area, but ripples are common along the inferior lateral border of the breast especially when bending over.
silicone implants do not suffer scalloping but have fold ripples in some patients. they may be placed over or under the muscle with excellent results.
patients with thin breast tissue with poor elasticity are at highest risk for cleavage and/or lateral ripples.
over inflating saline to eliminate ripples is ill advised.
placing larger silicone implants is ill advised.
at the last baker gordon meeting 2015, fat transfer to the tissue overlying the implants showed some promise of improving these difficult cases.
options including, silicone implants, fat transfer, and mastopexy should be discussed with and evaluated by an experienced board certified plastic surgeon.

Luis Villar, MD, FACS
West Palm Beach Plastic Surgeon
4.8 out of 5 stars 10 reviews

Deep Indentations After Breast Augmentation

If these are indeed ripples, they are the deepest and most visible I have seen.

  • If these are saline implants, switching to silicone should be considered
  • If these are above the muscle, placing them under the muscle should be considered. 
  • If neither, using a spacer such as fat injections or acellular dermal matrix should be considered. 

Whoever thinks about another surgery should find out from the previous surgeons if there were any unusual findings at surgery. The first surgeon might not have thought to check, but the second one probably was curious enough to check for abnormalities in the breast tissue that might have explained these folds. 

Putting in larger implants would not help, unless perhaps there was a large size decrease at the time of replacement. It is possible that a breast lift would help some, but an in-person exam would be necessary for making an actual recommendation.

Thank you for your question, and best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Deep indentations after implant removal

The deep indentations may represent the thinness of the tissues after removal of the other implants and now you have rippling. You may need to place the implants under the muscle or even add strattice to camouflage the area. Some wound consider fat grafting if this does not improve. 

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Deep Indentations After Breast Augmentation?

Though in thought and one choice of treatment I agree with Dr Rand, I have seen this, though rarely, in my 34 years of active practice. What has happen is the original implants most likely formed a firm capsule. When the removal occurred for rupture I assume you has a partial capsulectomy. Thus the tissue remaining was very thin. Replacement allowed the skin envelope to contract to fit the residual replaced implant size/space causing the severe rippling. Just increasing size will not correct the issue, as you now have discovered. Yes Dr Rand suggestion of acellular dermal matrice is valid but VERY expensive (2 sheet that size $4,000+/-) . I might recommend liposuction and fat grafting to "each" ripple. So  basically, there is an answer but the answer requires more expensive surgery. Hope this helps. Regards  

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Deep indentations after breast surgery

I have been at this for 26 years and have seen all kinds of wrinkles and ripples but never have I seen anything quite like what you have.  I don't know if those implants are saline or silicone, whether they are below the muscle, but if they aren't, they should be to get more tissue over them.  Also, are the dents the implants showing through exceptionally thin skin?  You might need to layer in a large sheet of Strattice to thicken the coverage over the implants.  Basically, as you can see, an in person exam would be absolutely required with a thorough review of what has been done, what implants you have etc...

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 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.