Best Course for Revision Due to Rippling and Wrinkling? (photo)

I am at one year post op. I previously had 325cc Saline implants above the muscle. I recently had the Saline switched to a 457 Silicone gel implant placed under the muscle due to rippling. I was hoping that this would fix the issue. I have had one PS who suggested repositioning the implants and another PS who suggested replacing them with smaller saline implants, using Strattice and doing a breast lift. The other problem is that I have pain everyday since the surgery that has not gone away.

Doctor Answers 8

Breast implant revision

You have rippling and also mild synmmastia. I recommend exchanging to a smaller implant, a neo-subpectoral pocket with Strattice re-inforcement.

New York Plastic Surgeon
4.9 out of 5 stars 326 reviews

Best Course for Revision Due to Rippling and Wrinkling?

Sorry that the ripples and pain are an issue because the frontal photo shows a very acceptable result. I might think about sub cutaneous placed fat grafts as a possible answer. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Breast revision

Fixing the capsule, putting smaller implants in, and adding an acellualr dermal matrix like Strattice may be a reasonable solution. An exam in person would be important.

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

Best Course for Revision Due to Rippling and Wrinkling? (photo)

I believe that the implants are too large for your body frame

I would recommend replacement with smaller moderate profile plus smooth round silicone implants placed under the fascia , possibly with mesh support

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Correct Breast Implant Rippling and Wrinkling?

I'm sorry to hear about the disappointing experience you have had after breast surgery. At this point, I'm sorry to say, you are dealing with a difficult situation. If your implants have been successfully placed "under the muscle",  then I think your best bet for an improvement ( not perfection), is the of  capsulorraphy techniques Internal suture repair/downsizing of breast implant pockets), the use of silicone gel breast implants and acellular dermal matrix (allografts).

Again, despite best efforts, complete elimination of the rippling/probably will likely not be possible given your very lean body type.

I hope this, and the attached link, helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

Best Course for Revision Due to Rippling and Wrinkling?

With large implants and thin skin cover it is tough to correct ripples, even, as you now know, by switching to silicone and moving the implants under the muscle. 

The breasts appear to have quite an acceptable appearance in the at rest position on the left. Flexing will always distort submuscular implants, and the forward posturing is aethetically the worst. (This is true for natural breast tissue--I doubt you would find this pose in Playboy on a full breasted model, implanted or not.)

I would urge against more surgery unless you are willing to downsize quite a bit and accept the expense of adding Strattice to add some additional coverage. you would need a lot, and it is quite pricey, and still may not meet your expectations.

Thanks for sharing your story and photos. All the best. 

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

Rippling after placement of gel implants under the muscle might require extensive treatment for good results.

I agree with the other answers you have received.  Acellular dermal matrix or fat injections can improve the situation after a smaller implant has been placed.  These are fairly extensive and costly treatments, however.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 36 reviews

Best Course for Revision Due to Rippling and Wrinkling

In general, saline implants placed above the muscle in someone with thin tissues have a higher risk for rippling and wrinkling visible through the skin. It is typically a reasonable solution to change implants to silicone and move the pocket under the muscle to reduce the ripples and wrinkles; however, this does not eliminate the possibility of wrinkles, especially in the lower, outer quadrant of the breasts. This is because the muscle does not cover the implant in this area. Also, silicone implants do forms some ripples. Usually, this is only visible in someone with thin tissues.

I caution my patients with thin tissues who want to go to a larger implant size. This may make issues worse in the long term because larger implants will likely thin tissues more. Strattice can add support. It is essentially like adding a thin leather-like sling in the lower part of the breast to support the weight of the implant and relieve the skin. Unfortunately, it is very expensive and it is very thin. It may not eliminate the ripples/ wrinkles completely. Fat grafting is very controversial in the breast, but some people are using it to help thicken tissues to improve ripples/ wrinkles.

If I was considering a revision procedure, I would ask my surgeon the chances of successfully accomplishing my goals and how likely it is that more revisions may be necessary. If I was not impressed with the chances and I was reasonably happy with my current result, I would probably choose to hold off on revisions.



Michael Vennemeyer, MD
Southlake Plastic Surgeon
5.0 out of 5 stars 48 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.