How do I fix rippling with gummy bear implants that are under the muscle? (Photos)

Question

I have low BMI. I am a 32 DD. It is on both breast when laying on my side and very ugly. I have had may implants for 6 years. I am 5'5 and weigh 118.

Richard Baxter, MD · Answer

You would do best with cohesive gel round implants, and the size and dimensions have to be matched to the width of your breasts and large enough to fill the skin envelope. If that would be too large of an implant for a thin person such as yourself, then a lift would be considered to reduce the skin envelope.

C. Bob Basu, MD, MPH, FACS · Answer

Dear amrn:If you had silicone gel implants placed 6 years ago in the USA, then it is very likely you have the "classic" natrelle implants or memory gel implants.   The good news is that since your procedure 6 years ago, we have a lot more in terms of options for silicone gel implants.  I would likely suggest you consider the true gummy bear implants - the Inspira Cohesive implants.  They have the highest fill-volume of all the silicone gel implants out there (meaning they are the gummiest).  These newer implants will likely significantly reduce your rippling.  In addition, although its hard to tell from the single view photo that you posted, I'm guessing you may have some loose skin and/or implant lateral malposition.   Depending on your physical exam findings, you may need some skin tightening or sutures laterally to correct any lateral malposition.    Of course a formal consultation and physical exam is needed to give you any meaningful advice.  Please see a board certified PS to learn more about your options.  Best wishes,Dr. BasuHouston, TX

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after breast surgery. 
Palpability and rippling of breast implants may be related to several factors. These include the amount of soft tissue and breast tissue coverage over the breast implants, the position of the breast implants (submuscular versus sub glandular), the type of implants (saline versus silicone), and the degree of overfilling of saline filled implants. Generally, weight loss will worsen any rippling/palpability of the implants.  
Correction of the rippling may involve further surgery including implant pocket exchange if possible (sub glandular to submuscular), implant exchange if possible (saline to silicone), and/or the use of allograft to provide an additional layer of tissue between the implant and the patient's skin.  I think that in your case, the use of highly cohesive silicone gel implants along with the use of acellular dermal matrix will be very helpful.
In-person consultation with board-certified plastic surgeons who can demonstrate significant experience helping patients with this type of revisionary breast surgery will be your next best step. Best wishes.

Cain R. Linville, MD, FACS · Answer

Are you sure those are gummy bear implants?  The true gummy bear implants are fairly new, and are made by Allergan, known as Inspira cohesive implants.  These implants almost NEVER do what I see in your pictures.  So first, I'd start there and suggest these new implants.  Second, we need to find a small amount of fat somewhere to do a little fat grafting into your breast skin since it's so thin.

Marc J. Salzman, MD, FACS (retired) · Answer

Thank you for your question and photographs. The problem is you have very little overlying soft tissue and the capsule and skin are stretched larger than the surface area of the implant. Although you say you have a "gummy bear" implant there are newer types of cohesive gels that are packed more tightly into the shell of the implant such that they do not wrinkle. The Allergan Natrelle Inspira  C implants provide for this lack of wrinkling but have a more firm feeling than a responsive gel implant. If you went a little smaller, and tightened the capsule with both sutures and electrocautery, and use one of these newer imlpants, I would think that these wrinkles would be improved tremendously. Hope that's helpful.

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