Generally speaking, there are only a few options to decrease rippling.
First, try a cohesive shaped implant. If you prefer a round implant, then you can either fat graft the tissue or use an acellular dermis to "thicken" the tissue.
Unfortunately, almost all reconstructive patients have some degree of rippling.
Rippling is more frequently related to the implant style in addition to thin tissues. Alloderm or Strattice are highly effective in reducing the appearance but a high profile implant will likely be important as well. Fat grafting is a very helpful adjunct and it will not require large amounts to be helpful. Lastly if you are wearing a bra that squeezes your implants together OR are sleeping in a way that causes your implants to be pushed toward the center over time this can lead to further thinning of the tissues in the cleavage area. Sleep on your back to avoid this.
Rippling of the breast after reconstruction is fairly common since a mastectomy removes all but the thinnest layer of fat beneath the surface of the skin. When there is less tissue between the implant and the skin, the natural rippling of the implants is often seen.
Options to try and improve this are as follows:
1) Use of a highly cohesive implant does not prevent rippling, but they seem to ripple less because of the nature of the gel that is inside the devices.
2) Subcutaneous fat grafting and placement of alloderm in the areas of rippling serve to place more natural tissue between the implants and the skin thus disguising the rippling.
Unfortunately, the options are somewhat limited. Placement of acellular dermal matrix such as Alloderm or Strattice may help camouflage the rippling. The Alloderm becomes incorporated, meaning it becomes a part of your tissues, rather than absorbing. Another option would be fat grafting to thicken the tissues so the rippling isn't as visible. However, there would be risk to the implant with this. Finally, a textured shaped implant may help, but depending on how thin your tissues are, you may still see or feel some rippling.
Thank you for the question. I think that the use of acellular dermal matrix can be very helpful for many purposes, including significant breast implant rippling/palpability. As you have heard, once it “takes”, it provides additional thickness/support/integrity to the tissues between your breast implants and the overlying skin. I hope this, and the attached link (demonstrating many cases where acellular dermal matrix has been utilized) helps. Best wishes.
Alloderm is indicated for reinforcing ir thickening soft tissue-- both of these are helpful after mastectomy and reconstruction. Once revascularized, Alloderm should persist fairly well where it is placed. I am not aware of any reports of Alloderm being absorbed, but if the material does not revascularize, then like any acellular mesh, it may be at risk of becoming infected. A combination of Alloderm in the upper pole and fat grafting when necessary, can help thicken the tissuesz and thereby hide the rippling or stepoff over the implant's upper pole. Discuss this with a board certified plastic surgeon near you. Best wishes,
Erik Hoy, M.D.
Alloderm is human dermis where the cells have been removed and leaves a scaffold for your own tissue to grow into. The alloderm should become part of your tissue and therefore should last. Alloderm is used very commonly in breast reconstruction and has an excellent track record. It can help reduce rippling. Generally it is used by placing under the area of rippling. In cosmetic procedures strattice is more commonly used (rather then use human dermis it uses pig dermis). It is a somewhat stiffer procedure but works in the same way. It also has a good track record in breast augmentation to correct secondary problems. Other options include the use of Seri or sometime fat grafting can help.
Alloderm is commonly used to minimize rippling and improve support of breast implants after expander to implant reconstruction, often at the time of the expander placement. There are other options such as SERI but Alloderm has the longest clinical history. See the link below for a 12-year follow up in a reconstruction case where the Alloderm was completely intact and integrated.
Rippling after expander based breast reconstruction is fairly common and is caused by a combination of things but primarily a fairly thin mastectomy flap and perhaps an overly large pocket. Pockets can stretch with time so this may not become apparent for several years.
Treatment is multifactorial but can involve fat grafting, tightening the pocket and /or adding acellular dermal matrix and implant change. Generally your own tissues take over the allograft with time and hopefully the thickening of tissues that it provides will last a long time but I do believe some of the thickness does go away and perhaps forever. I am not sure if long term studies are available on this specific question. Alternate products such as absorbable silk ( Seri) are being used to treated this condition. Studies suggests that tissues thicken with time. Hope this helps.