I have deep ripples when I bend over, in cleavage area when standing up right. 4 mo post op 385 HP Gel under muscle. (photos)

Question

I had no breast tissue before surgery due to breast feeding. My question is why didn't my surgeon tell me I was a high risk for rippling, I would have paid the extra to prevent this my first surgery. And now what are my options? I have an appointment tomorrow but I would like your expert opinions also

Martin Jugenburg, MD · Answer

I am sorry that you were unaware of your risk for rippling.
It can definitely be difficult when you spend so much money and do not get what
you want.

Rippling, or implant wrinkling which is visible through the
skin is common in patients who are very skinny and have very little fat or
soft-tissue (breast tissue, fat tissue, and skin) to hide the implant. I believe
the latter applies to you as you said you had very little breast tissue before
surgery.

Weight loss definitely worsens the situation, and
unfortunately, rippling also worsens with time as the implant puts pressure on the breast tissue and
thins the tissue to create deformities in the ribs causing them to hold a
different position in the chest.

Let me discuss the steps that could be taken to minimize
rippling.If
someone has textured implants, have it changed for a smooth surfaceIf
someone has saline implants, have it changed for a silicone implantIf
someone has large implants, have it changed for moderate sized implants so that
breasts can better conceal the implantIf
someone has the implant placed above the muscle (subglandularly), then have it
placed behind the muscle (submuscularly)Saline
implants ripple more over the muscle (subglandularly), but the rippling can be
hidden behind the pectoralis major muscle due to a thicker layer of soft tissue
that conceals 2/3rd of the top of the implant. Rippling may still
appear on the outer side of the breast, just above the breast fold and this is
especially true if you lean forward or bend to pick up something off the floor.

Final 2
solutions can be applied in any case:

Weight
gain – weight gain will allow greater soft-tissue coverage – i.e., padding –
the better the implants and rippling is concealed.Fat
transfer to the breast soft tissue for additional support and volume to area
where the implant is visible This
is the only surgical option, but there is unpredictability in the outcome due
to less than 60% fat graft take. Also note that rippling is often a problem for
thin patients, and such patients have very minimal fat for fat transfer.

In your case,
you have silicone gel implants placed behind the muscle so the best steps have
been taken. However, having the implants replaced for smaller ones may help.

I am unsure how your implant size was
selected, but a board-certified surgeon will always determine a suitable range
for the implant volume after conducting some breast measurements. Measurements
such as breast base width, the amount of breast skin stretch, nipple to breast
fold distance under maximal stretch, skin quality, chest wall asymmetries, etc.
has to be considered. This allows the implant size to be tailored to your
breast characteristics and breast boundaries.

So getting a smaller implants in addition to have fat
grafting to cover areas where implant rippling is visible will definitely help.Hope this helps

Jonathan Saunders, MD · Answer

the treatment of rippling is either fat grafting or placement of ADM. I would discuss this with your surgeon. the other remedy is weight gain , but I have never seen anybody do this yet.

Gerald Minniti, MD, FACS · Answer

Hello,The only way to have minimized this problem would have been to pay attention to the biodimensional measurements and used an implant based on those measurements. 385 cc implant was far too large for your breasts, and your photos depict how your current implant extends past the bottom and sides of your natural breast tissue. The easiest thing to do is change implants for smaller, form stable devices like the Natrelle 410 or Mentor Memory shape, and tighten the capsule to close off the areas that were opened in order to fit your current implant. The other alternative is fat grafting, but that is not as simple, easy, or reliable as it sounds. Go visit a few ABPS certified/ASAPS member surgeons expert in revision breast surgery.Best of luck!

Jerome Edelstein, MD · Answer

Hello,Thank you for your question. Unfortunately, even when placing cohesive silicone gel implants under the muscle there is a risk of seeing/feeling the implant where kin and tissue is the thinnest- typically at the bottom and sides of the breast. When you lean over an skin relaxes further, gravity can cause the implant to fold temporarily. The only way to further camouflage your implants might be to gain weight or fat grafting. You could discuss these concerns and options with your Plastic Surgeon when you see them next.All the  best

I have deep ripples when I bend over, in cleavage area when standing up right. 4 mo post op 385 HP Gel under muscle. (photos)

Answers (4)

Answer: Rippling

Answer: Rippling

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I have deep ripples when I bend over, in cleavage area when standing up right. 4 mo post op 385 HP Gel under muscle. (photos)

Answers (4)

Answer: Rippling

Answer: Rippling

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Recommended reading

Everything you need to know about Breast Augmentation

Our mission is to create a world where every investment in modern beauty is Worth It.