implant edge/rippling along inside: 6 weeks post BA, 350cc shaped silicone under muscle. (Photo)

Question

The right breast is protruding inward toward sternum and rippling. I can feel the rippling edge all around the R breast and it kind of ‘pops’ in and out of place. Sometimes it feels like the implant or muscle is floating or ‘lifting’ when I flex the pectoral muscle at all. Is this normal healing?! It doesn’t seem to be ‘dropping’ down into the bottom of the breast area either. Is this a normal part of healing process??

Ram Kalus, MD, FACS · Answer

Thanks for your question. It is indeed still a bit early and lots of healing needs to continue. That said, "animation deformity" is a recognized potential problem with implants under the muscle. Overall it appears that your result thus far is very pretty and proportionate. However, the subtle asymmetry and the palpable or visible rippling are certainly not desirable, but certainly a risk in a thin person such as yourself. In general, the softer the implant (less cohesive gel), the greater the risk of palpable or visible rippling. In our thin patients we are using almost exclusively the higher cohesivity or "extra fill" implants, but the trade off might be a slightly firmer feeling breast. The one photo you provided cannot help us determine exactly what is going on since holding the phone and shooting a selfie automatically activates your muscles a bit. If at rest, one implant is higher than desirable, there may be a role for an upper elastic bandeau, which can be very helpful early after surgery. Targeted massaging can also be helpful. You should discuss your concerns and any specific post-operative instructions with your plastic surgeon but take some reassurance that hopefully things will improve with time. If you remain concerned 9-12 months after your original surgery, you may have to consider revision surgery to address those concerns. Based on your result, it is safe to assume that your plastic surgeon is more than qualified to address your concerns and that is your best first address. Good luck in your ongoing healing.

James H. Rogers, MD · Answer

Your photo demonstrates rippling on the inner part of the right breast, and it appears that the left implant is higher than the right. The implants have not settled at six weeks, so the left may drop to the level of the right. Shaped implants are also textured to prevent them from moving, so it may not correct. Placing the implants under the muscle reduces the risk of rippling, but does not eliminate it. In thin patients , textured implants are more likely to have this problem. Changing to smooth implants may reduce the wrinkling. Use of tissue substitutes can be of benefit, but can be very expensive. Consult your surgeon to discuss your options.

Robert M. Tornambe, MD · Answer

bluejeanian. I appreciate your concerns but too early to worry. Your body needs time to heal and adapt to the implants. The skin and muscle over the implants must stretch a bit to allow the implants to settle into their final position. It is not uncommon to feel the edges of the implants, especially in thin patients, but this will resolve as your tissues stretch and the implants settle in.  While your appearance will improve fairly quickly, don't expect to see your final result for at least 6 months after surgery. Good Luck!

Mathew A. Plant, MD, FRCSC · Answer

I'm sorry to hear about your issues this soon after augmentation. It is still a bit early to judge final results, but if you are already seeing rippling then its not likely to improve as the swelling decreases. It may be amenable to fat grafting for coverage, or you may need a revision with alloderm to thicken the tissues. I'd suggest booking an appointment with your surgeon to be examined or get a second opinion from a local breast implant revision expert. Hope that helps!

Eric YK Li, MD · Answer

The rippling that you see if an unfortunate consequence of you being thin.  There is minimal coverage of the implant in that area by the overlying tissues, and therefore the rippling of the implant cannot be adequately camouflaged.  This is true even when the implant has been placed under the muscle because some surgeons release the muscle in that area to decrease animation, the very effect you are describing as "floating" or "lifting".  At this point in your recovery, best bet is to wait 6 months until your breasts are settled.  If the rippling persists there are options to improve it.  Hope this helps!

Gregory Sexton, MD · Answer

With the implant moving toward the mid-line, with rippling present, suggests the implant is not covered by muscle in that area. I would wait for 3 months, but if it continues, after 3 months you may want to ask your surgeon about repairing the muscle in that area.
Good luck,
Greg Sexton, M.D.
Columbia, S.C.

Richard Sadove, MD · Answer

Sorry for you. You are not my patient.Yes, some fat injection over the ripples is a good option. It is an office treatment.As for the flex deformity, it will not go away as long as your implants are under the muscle.Many plastic surgeons would have told you that putting the implant under the muscle would prevent you from having visible ripples.  It did not help in your case....Many plastic surgeons may not tell their patients that there is a risk for flexion deformity when implants are placed under the muscle. Sorry. It would not have happened if the implants were on top of the muscle.

implant edge/rippling along inside: 6 weeks post BA, 350cc shaped silicone under muscle. (Photo)

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