Help! Is there anything I can do to fix this ripple/implant knuckle?

Question

I’m 10 months post op (cohesive gel implant over muscle), and I’ve gradually noticed what feels like an air bubble or some type of squishy pocket within the crease on my left breast. Now, within the last couple of months, I can visually see a ripple. It’s not obvious, but it is disappointing, nonetheless. I may have lost 5-8 pounds, and I’m not sure if that would affect the appearance. Any recommendations? Thanks!

Richard Baxter, MD · Answer

The area of the knuckle in the implant is covered by muscle when the implants are under. Another possibility is that you are developing a capsular contracture, which squeezes the implant forcing it to make a fold.

Shlomo Widder, MD · Answer

Dear fungirl.     Thanks for submitting  your picture and sorry for your problem. The visible and most likely palpable ripple, can be eliminated by placing the implants under the pectoral muscle. This is my exclusive way of performing breasts augmentation and I never witnessed ripple medially. On thin patients , ripples can occur laterally and inferiorly , because the muscle does not extend to those areas.   If you want to avoid placing the implants under the muscles, you can get larger implants that will stretch the skin, however, with time the problem will come back again to haunt you.   Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures of redo breasts augmentation  in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.                         Best of luck,                                         Dr Widder

Daniel Barrett, MD · Answer

Dear fungirl9876,I understand your concern. However, without a proper assessment it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment. Only after thorough examination you can get proper recommendations and advice. Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

David R. Alfonso, MD, FACS · Answer

Based on your photos the ripple may be related to the implant being above the muscle. This may not change and sometimes fat grafting to the area can be helpful to hide the wrinkle

Janet Turkle, MD · Answer

Thank you for your question. More than likely, the squishy area is an edge of the implant. The weight loss might have made the implant a bit more palpable. Please have your doctor take a look.

Curtis Wong, MD · Answer

down the road, either the tissue has thinned (with your weight loss) or a contracture is closing in on the implant and squeezing it through a weak spot.  You should see your surgeon for an evaluation and recommendations.

Connie Hiers, MD, FACS · Answer

You could talk to your surgeon about a fat transfer just to give more tissue in that area. Also, your implants could be placed behind the muscle with the fat transfer.

Tim Sayed, MD, MBA, FACS · Answer

Your implants are over the muscle, so one approach would be to consider a pocket exchange to under the muscle/dual plane. This would likely allow the upper inner edge of the implant, where you are feeling/seeing the implant shell's contour, to be hidden and camouflaged by the muscle. In that location, you have a good chance of camouflage because it is high enough that the muscle attachment to the sternum would likely remain intact there to protect and shroud the edge. Technically what you appear to be seeing would not be "rippling," per se, but the implant edge, though the treatment options are largely the same. Fat grafting might be another consideration to add coverage, but there is a risk of injury to the implant if it is close to the skin. This needs to be assessed in person to properly and formally counsel you on the options.

Steven Wallach, MD · Answer

I can not see it on the photo, but it is likely due to the thin soft tissue coverage. An ADM or fat grafting might be reasonable.

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after breast augmentation surgery. Based on your description and photograph, it is very likely that your feeling/seeing the breast implant.   Some general thoughts may be helpful to you:Palpability and rippling of breast implants may be related to several factors. These include the amount of soft tissue and breast tissue coverage over the breast implants, the position of the breast implants (submuscular versus sub glandular), the type of implants (saline versus silicone), and the degree of overfilling of saline filled implants. Generally, weight loss will extension weight any rippling/palpability of the implants. Deflation of the implants will also increase the rippling/palpability of saline implants.
Correction of the rippling may involve further surgery including implant pocket exchange if possible (sub glandular to submuscular), implant exchange if possible (saline to silicone), and/or the use of allograft (acellular dermal matrix) to provide an additional layer of tissue between the implant and the patient's skin.  
In-person consultation with board-certified plastic surgeons who can demonstrate significant experience helping patients with this type of revisionary breast surgery will be your next best step. Best wishes.

Help! Is there anything I can do to fix this ripple/implant knuckle?

Answers (11)

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