Breast Implant Revision- Overs to Unders for Rippling? (photo)

Two years ago I had 410cc textured High Profile, silicone cohesive gels placed over the muscle. It took me from a 34b to 34D.I was told I needed to go over the muscle to correct slight sagging (which I don't think I had much of). Since I had the surgery I have experienced some rippling of my left breast and some more sagging. Would I need a breast lift? If so which lift? Different profile implants or go bigger? Go under the muscle?Internal Sutures?What are the recommendations for my revision?

Doctor Answers 9

Place Implants Under

Thank you for your photographs.  Placement of the implants beneath the muscle will help the wrinkling.  A lift might be needed but this is best determined by an examination.

Dr. ES

Rippling of implants

Upper pole rippling can be caused by a thin soft tissue coverage. Placing  the implants under the muscle adds another layer of support and can help.  As for lifting, it depends upon how you look in person. Tough to say from photos.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 22 reviews

Correction of rippling and sagging with 410 implants

First the disclaimer: No one can give you specific advice online. In general, here are the issues: Placing implants over the muscle does not correct sagging, only makes it worse after a while as you report. Second, the types of rippling shown in the pictures, over the upper part, are called traction ripples. Since the muscle covers only the upper part of the implant, it can help to put the implants under. However traction ripples are also helped by supporting the implant from below, and there are various ways of doing that. Third, if you had some sagging before implants then some sort of lift needs to be part of the plan.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 38 reviews

Implant rippling

I would recommend placing new silicone implants (smooth wall or form stable) under the muscle. This should correct the rippling. For rippling in other areas, allograft or suturing might be needed. I think the biggest issue here is the above muscle placement, which has a higher incidence of rippling.

Best Breast Revisionary Operation for Me?

Thank you for the question and pictures.  As you know, it is difficult to give you precise advice online, but given your main concern of breast implant rippling, replacing breast implants in the sub muscular pocket will certainly be of benefit to you. This procedure along with the use of allograft and/or internal sutures (capsulorraphy) will likely significantly improve the outcome of the procedure performed.

 Ultimately, you will benefit from in-person consultation with well experienced plastic surgeons who can demonstrate significant experience with revisionary breast surgery.

You may find the attached link helpful to you as you learn more about options available.

Best wishes.

Texturized implants have a higher rate of visible and palpable rippling.

Probably the best solution would be to swap out to smooth walled implants. Silicone gel is less likely to produce contour irregularities and saline. Texturized implants were introduced to decrease capsular contracture which they don't.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 23 reviews

Breast Implant Revision- Overs to Unders for Rippling?

In my opinion based ONLY on the posted photos you have an acceptable though could be improved result. Best to obtain IN PERSON evaluations from boarded PSs in your city. 

Rippling of implants

One of the most important things a breast augmentation patient needs to understand is that breast augmentation is an inherently imperfect operation. There are many things that can cause dissatisfaction that are not complications per se. Whether is it is rippling, some degree of firmness, roundness, excessive fixation or mobility, they are what make breast augmentation inherently unnatural. This does not mean you cannot have very natural looking, or natural feeling, excellent and desirable results. It just means that you have to prioritize these imperfections and decide on which ones you can live with. Otherwise, it is possible to get caught in 'chasing the imperfections' where correction of one imperfection leads to another undesirable imperfection. In general, the more disproportionate the implant is to your natural breasts, the more these imperfections will appear. I think that is the fundamental situation with your case.

Robin T.W. Yuan, M.D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 10 reviews

Breast Implant Revision- Overs to Unders for Rippling? (photo)

Your questions and photos are excellent, but specific.  There is also important information omitted, such as are you happy with areola size?  What is your tolerance for larger implants?  What is your scar tolerance?  Realself is an excellent online forum for exchange of knowledge and general advice, but in my opinion, the specific questions you ask are best answered in personal consultation.  Recommendations for treatment should only be made in the context of your personal preferences, lifestyle, findings on physical exam, etc., information best discussed in the office of your surgeon.

Steve Laverson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 44 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.