Implants Still Have Ripples After Exchange?

42 yrs old. 119 lbs. 1wk post op from 17yr old saline 400 CC to 595 gummy bear subglandular due to drop and extreme rippling. I asked specifically for sub muscular because im thin. Still have rippling.Will this go away? What are my options? Recourse? PS says this is due to muscle memory???

Doctor Answers 5

Subglandular implants and rippling. And defining Gummy Bear!

Subglandular implants certainly are at higher risk of rippling than submuscular. I am not clear from your post if your revision included a pocket change per your request, but I certainly would have recommended this pocket change to submuscular if you were my patient. A couple of things could have happened if this pocket change was attempted but you still have severe rippling. 1) The implants have popped out from under then muscle and went back into the old subgladular pocket if it wasn't sewn closed 2) The implants were never put submuscular. Once healed you can do an easy manuver to see where the implants are placed. Stand in front of a mirror with shirt/bra removed. Take your hands and put them together in front of your breasts. Push your hands together very hard, thereby engaging the pec muscle. If the implants displace (move) laterally (to the side) or cleavage widens/changes, and/or superiorly and laterally then the implants are definitely under the muscle. If they don't move at all, I would guess they are likely subglandular. If they're subglandular they need to be moved below the muscle. If they're below the muscle then we need to look at the exact implant you have.

The term "Gummy Bear" is used very loosely online. Most online sources/patients are using that term to describe all of the latest generation silicone gel implants (versus the older liquid silicone implants). This is not entirely accurate as there is some variability among the different models and styles of implants. True "gummy bear" implants are Allergan 410 or Sientra, textured, anatomic implants (check your device tracking ID card). If you have a Mentor device or round (smooth or textured) Allergan or Sientra device they are cohesive silcone gel but not true Gummy Bear. The standard round silicone gel implants certainly ripple far less than saline, but still can have some visible and palpable rippling in thin patients when placed in the subglandular plane. The Allergan 410 has very little, to no rippling, but delivers less superior pole fullness (think clevage "pop") and is firmer than a standard gel implant. For this reason I rarely recommend them for primary augmentation, but they at least deserve discussion in revisions with significant rippling.

Discuss your concerns with your surgeon. Obtain the operative report as well. I am not familiar with "muscle memory" causing rippling, and if the pocket was change from above to below the muscle there shouldn't be any memory... I can see if the anterior capsule wasn't removed with a capsulectomy, but this should have been addressed with the pocket revision. If you feel that your concerns are not being addressed then I would always recommend a second opinion, but you're far too early for a revision.

Texas Plastic Surgeon
5.0 out of 5 stars 86 reviews

Rippling after implant exchange

Rippling develops in very thin patients with little to no soft tissue coverage over the implants.  If the implants were then placed under the muscle, it can help with superior pole camouflage because of the extra layer of coverage.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Silicone gel implants are not immune from contour issues.

Silicone gel implants can be placed above or below the pectoralis muscle. In your particular situation placement below the muscle was certainly be a consideration preoperatively. Nevertheless, it implants below the muscle – silicone or saline can demonstrate contour irregularities in thin patients.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Options for rippling with gummy bear implants

As you know without more detailed information and a personal consultation, only general advice can be given online. For a petite person, 595 is a very large size and implant coverage & support will be a problem with any type of implant. Going under the muscle will help with coverage of the upper part, but will not add support or coverage on the sides and bottom. With the gummy bear implants, the type of rippling I have seen is on the upper part, called traction ripples, so under muscle would seem to help. If this is not your issue, Strattice to cover and support, and consider smaller implants.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Continued Breast Implant Rippling after Revisionary Breast Surgery?

As you can imagine, it is difficult to give you specific advice without viewing pictures. Generally speaking, if your breast implants have successfully been placed below the pectoralis muscle, then the next option to improve your situation with breast implant rippling would be the use of acellular dermal matrix.

 To answer your question, rippling of breast implants does not necessarily get better as time goes on. However, always best to evaluate the end results of the procedure performed several months after it was performed.

 You may find attached link helpful to you for more information regarding revisionary surgery performed for similar situations.

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 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.