Above Muscle Silicone Implants After Breastfeeding; Breast Sag, Ripple, Are Soft. What to Do? (photo)

Hi doctors, I had a BA in 2006. After kids my breasts became deflated, with stretched skin.My ps decided for an over the muscle BA with textured silicone implants because I wanted them to look as natural as possible. Now after having 2 more kids and bfing for over 3 years, this is what I have now. Rippling, sagging, soft breasts, and I can readily feel and see my implants through my skin. I don't want to be larger than I am now, if anything smaller.I really want to avoid as much scarring I can

Doctor Answers 6

Options for Revisionary Breast Augmentation Surgery?

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Thank you for the question and pictures.

You may benefit from revision breast surgery;  options include replacement of implants  and to the sub muscular space, use of capsulorraphy techniques,  use of acellular dermal matrix  and/or breast lifting.

I would suggest that you meet with well experienced board-certified plastic surgeons who can demonstrate significant experience with revisionary breast surgery. Communicate your goals clearly (I prefer the use of goal pictures);  this communication will be critical in helping determine the best course of action/operation to  accomplish your goals.

Best wishes.

Ripples with above the muscle textured implants

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Ripples are problematic more commonly with above the muscle placement and with textured implants. With your arms extended it is hard to tell how much ptosis (sag) is present. Based on what I see in these photos, the best solution is to replace your implants with smaller smooth gel implants, to move the implants behind the muscle. A breast lift may also be advisable. If your soft tissues are not sufficient, you may also be advised to add acellular dermis, an animal derived soft tissue substitute, to add additional coverage over the implants. 

Best wishes and good luck. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon


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Breast Implant Rippling most often occurs when there is insufficient soft tissue coverage due to little overlying body fat and breast tissue. Implants placed beneath the muscle help to minimize this phenomena but the lower and outside breast (as pectoralis muscle is no longer present), towards the cleavage where the muscle thins out or on top of the breast where breast tissue is often lacking are the most common places to see rippling. It is often accentuated with certain positions (e.g. bending over,or leaning). Most of the time, rippling is felt along the outer side of the breast and the inner side of the breast next to the cleavage. Breast implant waviness (rippling) that is felt but not noticeable to the eye is very common and should not be a concern. However, when rippling is visible, patients are often self-conscious about their appearance.
Factors that are associated with increased rippling include:
  • Traditional Saline implants (IDEAL® Saline implants less likely)
  • Textured implants
  • Large implants
  • Thin patients with low BMI
  • Implants placed above the muscle
  • Prior history of rippling
Factors which are less likely to have rippling include:
  • Heavier and larger breasted women
  • Using a highly cohesive form-stabile silicone implants (gummy bear)
  • Smooth implants
  • Smaller implants
  • Submuscular placement
Once rippling occurs it is very difficult to correct. Rippling can be minimized by placing a biologic fabrics (e.g. AlloDerm®, Strattice™, SERI®), submuscular conversion if implants are above the muscle, fat transfer, use of adjacent tissue (muscle or fascia) if available, and in persistent cases implant removal and fat transfer. Seek the care of the best board certified plastic surgeon possible with experience in breast revision surgery.


Breast wrippling

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Thanks for an excellent question and good pictures.  If you were my patient I would do a site change and place new implants in the submuscular space.  This will help eliminate all the rippling on the top and inside of your breasts and reduce the wrippling on the side. Good luck.

Rippling implants

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In my experience textured implants tend to show rippling more than smooth ones and are also more likely to be palpable (you can feel the edges more easily). So replacement with smooth implants should help. Without an exam it it impossible to make the best recommendation for you. You should seek a consultation with at least one plastic surgeon certified by the American Board of Plastic Surgery who can advise you about your options. Good luck to you.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon

Breast revision surgery

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You may very well be a candidate for revision surgery. Your tissues are very thin and they may benefit from more tissue coverage.  DIfferent implants may help, as well as acellular dermal matrix.  An exam in person would be helpful.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.