Dr. Insisted on over the Muscle Silicone Implant Hardly No Breast Tissue and Now Have Rippling a Month Post Op is This Normal?

Hi at my consultation I asked my Dr. for under the muscle saline implant ,but he insisted silicone was the way to go . I had hardly any breast tissue I didn't even fit an A cup , he said it was in my best interest for over the muscle and to have silicone and he said i wouldn't have a prob. with rippling ,Well now im 4 weeks post op and i can feel a lot of rippling . im soo disappointed :( i did do my research but took his prof. Advice .Will Doctors generally correct something like this?

Doctor Answers 9

Dr. Insisted on over the Muscle Silicone Implant Hardly No Breast Tissue and Now Have Rippling a Month Post Op is This Normal?

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            In most women seeking breast augmentation, the existing amount of breast tissue is small and is the reason for seeking breast augmentation.  Thus, in most women, the implant should be placed under the muscle.  Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Subglandular implants

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Thank you for your question.  Sorry to hear you are not happy.

In my practice, I place implants under the muscle in the majority of cases. The extra coverage by the muscle helps to conceal the implant and this is especially important in women with smaller breasts and little body fat.

Having said that, the muscle does not cover the outside part of the implant nor the lower part of the implant.  It does cover the top half or in some patients only the top third of the implant. this depends on the individual anatomy of the patient. If you are feeling rippling on the outside or lower part of the breast this may not improve if the implants are changed to submuscular.

Whether the cost can be adjusted is up to the individual plastic surgery office.

Breast implants and rippling

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If a patient does not have a lot of soft tissue coverage then I prefer to place them under the muscle as well. This will give more soft tissue coverage in the upper pole.

Incorrect Implant Site

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Typically, if a woman is seen in my office with small breasts (not enough to cover the implant) then I place the implant (silicone or saline) beneath the muscle.  This helps to hide the implant edges.  Silicone does show less rippling versus saline implants but if placed beneath thin tissue silicone will still show ripples. This can be corrected by removal of the implants and placing them beneath the muscle.

Dr. ES

Unhappy due to rippling after above the muscle silicone breast implants

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Sorry about your unhappiness with your breast augmentation results. Placement of any type of implant, silicone or saline, above the muscle under thin breast tissue can result in rippling as is apparent in your case. At this point it is too early to convert to an under the muscle pocket, which can reduce rippling especially at the upper half of the breasts. If you really want to undergo a revision, you will need to speak with you surgeon about different options of taking the implants out and revising the pocket. 1) You could remove the implants now, which may allow your current pockets to seal up on its own. You would require another surgery to create new under the muscle pockets at a later date. 2) You could wait for the current pockets to mature by allowing them to heal for several more months. Once mature, your surgeon could then do a pocket "site" change and place new implants under the muscle. However, if this is not performed correctly, the new implant could pop or slide back into the above the muscle site. This particular technique takes higher level skills and experience. Thank you for sharing your question and concerns. Best of luck.

Rippling after augmentation

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Rippling is more common or less common based on a number of factors, as noted by the other answers.  It would be nice to have more information as to why your surgeon "insisted" placing the implants in front of the muscle "ws in your best interest".  You should request an explanation.  As to whether your surgeon will replace the implants under the muscle, you will need to speak to them about their revisIon policy and costs.  At this point, you should probably wait a few months before considering elective revision surgery.

Todd C. Case, MD
Tucson Plastic Surgeon

Rippling after Breast Augmentation?

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Sorry to hear about your concerns after breast augmentation surgery. Although breast implants can “ripple” regardless of their positioning,  this problem is more commonly seen with breast implants placed in the sub glandular position ( especially with “hardly any  breast tissue”).

 At this point, given that the decisions have been made and the operation performed, best to allow for several months to pass before evaluating the and results of the procedure. If you continue to have significant problems with breast implant rippling, revisionary breast surgery may be helpful to you. Be careful with your decision-making at that point and make sure that your plastic surgeon has significant experience with revisionary breast surgery.

Best wishes.

Dr. Insisted on over the Muscle Silicone Implant Hardly No Breast Tissue and Now Have Rippling

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Ripples are a fact of life with implants. They are more common with saline than silicone, with textured implant than smooth, and with above the muscle placement rather than under. They are more common in patients with small amounts of breast tissue, and with larger implants. 

There are many factors that go into the choice of incision, implant, and position, and all have pros and cons. Without more info I can't tell the basis for your surgeon's recommendation. 

It is worthwhile to wait at least three months for the implants to settle, because these ripples may become less apparent as the tissues adapt to the implant. If these persist and are troublesome enough, revision considerations include moving the implants to submuscular position, and/or using Allergan style 410 shaped implants.  None of these can guarantee no ripples.

All the best.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Rippling one month out?

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Hello Cici. Thanks for sharing your concerns. There are several factors that can lead to ripples; saline implants are higher risk than silicone, above the muscle, thin breast volume, and/or large breast implant volume. If you did your research then a realistic expectation would be that rippling was likely in your case. This is especially true since you stated your surgeon recommended above the muscle. At this point, a revision surgery may be highly beneficial to reduce rippling. Consider discussing a smaller implant, changing to silicone and going below the muscle. Most surgeons would recommend revision if ripples are visible. Surgery is not always recommended when you only feel the ripples in the implants, which is considered normal in many cases. The best person to discuss this issue is your plastic surgeon. Best wishes, Dr. Aldo.

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.