Loose Skin and Rippling 4 Weeks Post Under the Muscle Silicone Breast Revision Surgery (photo)

I went from over to under the muscle silicone revision surgery. My right breast has loose skin on the outer side, unnatural shape, rippling in cleavage and uneven under crease of breast. My left breast has a severe "dent" and rippling. My PS says it will all settle with massage but I can not see how. What went wrong and how can I fix it? How long do I need to wait to have it corrected?

Doctor Answers 7

Rippling following revision of breast augmentation

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Without seeing pre-operative photos and knowing exactly what was done during surgery (eg. how was the muscle divided, was your implant size changed, what was done with the capsule), it is impossible to evaluate how things may turn out.  It will generally take at least 3 to 6 months to get an idea of your final result. 

If the issues you see above persist, you may require revision of your implant pockets and may benefit from the use of Strattice (an acellular dermal matrix) which can be used to support the implant (maintaining its shape) as well as for camouflage in areas of vsible rippling.

I would recommend close follow-up with your plastic surgeon.  If your appearance does not improve with time and your surgeon does not present options for revision, obtain consultations with board-certified plastic surgeons who are experienced at revising breast augmentations.

Good luck.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You should continue to follow-up with your plastic surgeon in order to receive formal evaluations and maintain your doctor patient relationship.

Houston Plastic Surgeon
5.0 out of 5 stars 29 reviews


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Breast Implant Rippling most often occurs when there is insufficient soft tissue coverage due to little overlying body fat and breast tissue. Implants placed beneath the muscle help to minimize this phenomena but the lower and outside breast (as pectoralis muscle is no longer present), towards the cleavage where the muscle thins out or on top of the breast where breast tissue is often lacking are the most common places to see rippling. It is often accentuated with certain positions (e.g. bending over,or leaning). Most of the time, rippling is felt along the outer side of the breast and the inner side of the breast next to the cleavage. Breast implant waviness (rippling) that is felt but not noticeable to the eye is very common and should not be a concern. However, when rippling is visible, patients are often self-conscious about their appearance.
Factors that are associated with increased rippling include:
  • Traditional Saline implants (IDEAL® Saline implants less likely)
  • Textured implants
  • Large implants
  • Thin patients with low BMI
  • Implants placed above the muscle
  • Prior history of rippling
Factors which are less likely to have rippling include:
  • Heavier and larger breasted women
  • Using a highly cohesive form-stabile silicone implants (gummy bear)
  • Smooth implants
  • Smaller implants
  • Submuscular placement
Once rippling occurs it is very difficult to correct. Rippling can be minimized by placing a biologic fabrics (e.g. AlloDerm®, Strattice™, SERI®), submuscular conversion if implants are above the muscle, fat transfer, use of adjacent tissue (muscle or fascia) if available, and in persistent cases implant removal and fat transfer. Seek the care of the best board certified plastic surgeon possible with experience in breast revision surgery.


Working with Thin Skin and Breast Tissue in Revisional Breast Surgery

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Patients with minimal breast tissue and thin skin require special consideration in revisional breast surgery.  It is important to carefully choose the best implants for a patient's particular needs.   Some implant types ripple more than others.  Strattice or other dermal matrix implants can reduce rippling and irregularities of the breasts.  Surgical technique can improve results.  Fat grafting can smooth irregularities when present.  In the photos you have provided for my opinion, the left pectoralis muscle appears irregular near the cleavage.  I would discuss this finding and your concerns at your next visit with your plastic surgeon.

Stephen Bresnick, MD
Los Angeles Plastic Surgeon
4.8 out of 5 stars 34 reviews

Loose Skin and Rippling 4 Weeks Post Under the Muscle Silicone Breast Revision Surgery (photo)

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Yes you could have revision fat grafts to correct the differences at anytime. But to achieve perfection is very hard. 

Revison implants surgery

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It isvery tough to comment without seeing you in person and knowing what was done before and how your breasts looked. Very often after several operations the tissues thin out and they are tough to work with.    In the meantime you ahve to let things settle a bit. You may also need strattice placed to help with the rippling.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Challenges of breast implant revision

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The best chance to get things right is the first time, and revisions can pose many challenges. Your tissue has thinned, and 'controlling ' the pocket shape can become more difficult. Your photos demonstrate that even silicone gel implants can show through and ripple. The dent may be an area without muscle coverage, and the uneven crease a flaw in the pocket shape. For now you should wait and see how things look after the implants conform the new pocket. There are fixes, and very cohesive implants might further reduce ripple, but for now have faith and see what happens.

Best of luck, peterejohnsonmd.com

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Results of Breast Revisionary Surgery?

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Thank you for the question and pictures.

Given that you are only 4 weeks out of your surgery,  is much too early to judge the final results of surgery. It will take several months and even up to a year for the breast skin to redrape  over the breast implants now in the sub muscular position. You may find that you are much happier with the appearance of the skin several months from now.

Unfortunately,  rippling is much more of a difficult situation to deal with. Unless you were to gain weight ( and coverage of the breast implants),  use of a cellular dermal matrix ( allograft) may be necessary in the future.

For now I would advise patience  and continued follow-up with your plastic surgeon.

Best wishes.



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.