Breast Implant Rippling - What is causing this and how can it be fixed?

Question

I am 12 months post-op from my breast implant augmentation (Natrelle gummy 240cc submuscular placement, moderate profile). I started to have a minor ripple in the left breast 4 months post-hop, and rippling has gotten worse. I did take Singulair (montelukast sodium) for 2 months post-op. My physician, who has many years of experience and positive reviews, said the rippling could be due to weight loss (even though right breast has no rippling) and would not diagnose it as capsule contracture. When I flex the left breast, the rippling is much worse, and implant appears different than when the right implant is shown flexing. Is the rippling possibly due to capsular contracture or instead surgical execution? If I were to pursue a revision, would you recommend I ask for a second opinion from another physician if I want a revision, or ask my original physician for a revision?

Gregory A. Buford, MD, FACS · Answer

From the photos you sent, it appears that you have very low body fat and probably very little glandular breast tissue.  As such, rippling is going to be much more noticeable.  And if you lose any more weight this can get worse.

Highly cohesive silicone gel implants in addition to bioresorbable grafts in combination with alloClae (off the shelf processed fat) could potentially be very helpful here to create a thicker soft tissue envelope around the actual implant and reduce rippling.

I doubt that this is due to surgical technique but would also discuss this with your surgeon.

I hope that helps and wish you the very best.

Gerald Minniti, MD, FACS · Answer

That's a double bubble, and it is caused by your original inframammary crease, which was likely different  (closer to the nipple) on the affected side. This is confirmed by muscular contraction making it worse. My recommendation is stop taking Singulair. It has never been shown to be effective at anything, quite frankly. If you would like this problem to be completely fixed you'll need a revision surgery. My recommendation for you, even with your lean body habitus, is to abandon the subpectoral/dual plane pocket and have your pectoralis muscle repaired and replaced back onto the chest wall where it came from. A new subfascial pocket can be created and a Motiva breast implant placed with mesh. This will give you a smooth result without the fear of double bubble and a low risk of rippling. Of course, a physical examination would be required to confirm this surgical plan. In certain individuals, fat grafts can also be place centrally near the sternum to soften that region.

Emre Guvercin, MD, FEBOPRAS · Answer

Based on the photos, there appears to be a more noticeable double-bubble deformity on the right and a minimal one on the left. This is not necessarily capsular contracture, particularly if the implants remain soft. In a revision, the lower breast anatomy and implant position should be addressed rather than simply treating the visible rippling. The pectoralis muscle can be selectively released/repositioned as needed, and if the nipple-to-inframammary fold distance is greater than approximately 7 cm, this distance can be shortened by reconstructing and elevating the inframammary fold. This would allow the implants to sit higher and more securely on the chest wall while also reducing the appearance of lower-pole sagging and the double-bubble contour. I would recommend obtaining a second opinion from a surgeon experienced in revision breast surgery and inframammary fold reconstruction before deciding on the exact approach.

Breast Implant Rippling - What is causing this and how can it be fixed?

Answers (3)

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