Mastopexy to Improve Gel Implant Rippling

I have subglandular 300cc gel implants. Had consultation today for lift. Main concern is visible rippling. Surgeon I consulted today showed me how a lift by repositioning areolas as drawn, and removing some skin (see pict) would greatly improve rippling. I'm all for going the less invasive/costly route but I wonder if I am being foolish not having the implants placed under the muscle as well. Would it make that much of a difference? At 49 I don't need perfection, just want to improve rippling.

Doctor Answers 13

Breast Lif or Mastopexy and Silcone Breast Implants in Los Angeles

As this patient has experienced silicone breast implants can also ripple, especially when placed over the muscle. To lessen breast implant rippling, it is a good idea to try to move them as much as possible under the muscle; at least the superior and medial aspect of them. Breast Lift and Mastopexy can help to a lesser degree by tightening the breast tissue.

Beverly Hills Plastic Surgeon
4.4 out of 5 stars 49 reviews

Fat grafting for breast augmentation

You are a good candidate for fat grafting to the breasts.  You may even want to later consider a short scar mastopexy similar to the techniques described by Dr. Madeleine LeJour (Belgium) and Dr. Elizabeth Hall-Findley (Banf, Alberta).  Fat grafting to the breasts should be done after 4 weeks of preparation with the Brava device ( which is an external breast exanpsion device but since you have implants they could be removed and you could have fat grafting at that time with closure of the capsule pocket.  Once healed you would require your first 4 weeks of home treatment with the Brava device followed by a second session of fat grafting to the breast.  You may require 2 or more fat grafting treatments to achieve your goal size.  This form of treatment would allow you to completely rid yourself of an implant which naturally tends to ripple and be visible beneath thin tissues.  Placing the implant under the muscle will only partially correct the rippling problem. Remember I think you'll still likely need a short scar mastopexy but that is a personal decision for you to make.

Louise Ferland, MD
Richmond Plastic Surgeon
4.2 out of 5 stars 11 reviews

Rippling after subglandular implants

Rippling and sagging  following subglandular implants can be corrected in the following way

1  If saline saline implants are causing  rippling ,convert to silicone --preferably smooth moderate   profile plus,as this implant  is least likely to cause rippling

2 I do not believe that submuscular placement is the solution ,Sub muscular placement  can cause abnormal distortion and movement  of the implants when the pectoral muscle is tightened.I prefer subfascial placement

3 The sub areolar variation of the circumareolar  breast lift has less tendency to stretch.The vertical scar can usually be avoided  with this technique,especially if the lower pole is supported with a mesh or dermal sling(Internal Bra )

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Lift over or under the muscle?

A periareolar lift most likely will not correct the visible "rippling" problem. This problem is not only derived from the capsule but it mainly has to do with the adequate amount and quality of the tissues that are covering the implants    ( skin, gland, muscle,etc.). My patients have had the best results with a circumvertical lift and replacement of the implant to the submuscular space if the covering tissues are thin.

Arturo Guiloff, MD
Palm Beach Gardens Plastic Surgeon
4.7 out of 5 stars 21 reviews

Rippling after subglandular breast implants

Based on your photos I would recommend converting your implants to a subpectoral location (under the muscle) to minimize your rippling. I would also recommend a circumvertical mastopexy (lollipop lift) to give a nicer contour to your breasts. An areolar lift alone will not give you a very good result. 

I recommend consulting with one or more board certified plastic surgeons for a more comprehensive exam and review of your surgical options.

Best wishes,



William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 376 reviews

The IDEAL Breast Lift to Minimize Rippling

A few points:
1. The fact that we are seeing rippling / in-folding NOW means that the ripplings of your implants are NOT covered by the amount of breast tissue you posses. IF you had a sufficient amount of breast coverage over the implants, such rippling would exist at the implant level but would not be visible or palpable at the surface. So, you REALLY should consider going UNDER the muscle (In other words, your hunch was right!)

2. A Periareolar lift (the kind drawn on your breast), in MY opinion is the wrong operation if you want to have truly attractive and perky breasts. You already have too much loose skin along the mid and bottom of the breasts. Skin which will NOT be removed or tightened merely by repositioning of the nipple/areola complex. To get a much better result, you will need a variation of the Lollipop Breast Lift (Mastopexy). Please, refer to the enclosed link for an explanation.

Good Luck.

Peter A Aldea, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 109 reviews

Lifts aren't the cure for rippling

Your best chance of fixing the rippling is to go under the muscle.  A lift alone would almost certainly leave you disappointed and the periareolar lift marked on you will also leave you disappointed with the inadequate lift and re-shaping of the breast it will give you.  You will likely be left with a flat, baggy breast with loose skin in the lower pole and ripples still present.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Breast lift alone not adequate to fix rippling implants

It is important to point out that the surgeon who has examined you is in the best position to make a recommendation. Having said that, I have to say that a breast lift alone is not usually sufficient to fix rippling from implants over the muscle. Going under is the best solution for upper pole rippling in most cases.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 53 reviews

Be Careful!

There are several issues that you need to consider. First, you have relatively large implants and thin skin. A "donut" mastopexy will leave you with a wide scar and only mild improvement in rippling. Placing the implants below the muscle may improve upper pole rippling but if the rippling is in the lower pole it will likely remain to a certain degree. Your options should start with a standard mastopexy and might also include a submuascular placement and if you really hate ANY wrinkling, consider decreasing your implant size and possibly using a dermal matrix material. But this starts to get expensive. This is a more complex issue than it may seem and deserves careful assessment and planning. Best regards, KC

Kirk A. Churukian, MD
Los Gatos Plastic Surgeon
5.0 out of 5 stars 6 reviews

I think you will need more that what is drawn

I don't think you will get enough tightening of the skin with the lift just around your areola.  It will take a more formal lift as well as tighten of the internal capsule ( capsuloraphy ) to do the job.  This will make more scars on your breast skin, but this is usually well tolerated if the breast are shaped nicely and the wrinkling is better. Good luck, Dr T

Scott Tucker, MD
Winston Salem Plastic Surgeon
5.0 out of 5 stars 30 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.