I had my breast augmentation almost 7 months ago. I have bottomed out and I believe my problem is minimal but I'm starting to get visible rippling in my cleavage on my bottomed out breast. I don't like the rippling but I can still hide it. I'm trying to decide if it's worth a revision. My question is "Does bottoming out typically get worse with time?" "Will the rippling become more visible?" I'm scared a revision will make my results look worse.
I'm 6 Months Post-op and Slightly Bottomed Out. Rippling Starting to Appear. Will It Get Worse with Time?
Doctor Answers 9
Bottoming out issues
I generally agree with the previous answers. The lower pole on the right is slightly stretched compared to the left and slightly less than perfect but well within normal for minor breast asymmetry. It will probably stay about the same over time but it's not possible to know or control it.
Rippling is a separate issue although to the extent that the lower pole on the right is stretched out it will have less coverage over the implant and thus make rippling more apparent. Saline implants feel inherently ripply but if they are sized, positioned, and filled properly (and have a smooth surface) they shouldn't look ripply. If coverage in the lower or lateral part of the breast (where the muscle doesn't cover) is thin then the best solution is a smooth surface, round, gel-filled implant. Gel implants can still ripple in certain situations but they don't look, act, or feel ripply under normal conditions.
I would not recommend gaining weight just for covering breast implants but this does increase the padding over the implant. I would also not recommend revising at this time unless you choose to change implants for size or type reasons.
Bottomed Out Breast Implants and Rippling
The reality is that implants continue to thin tissues for years, and that your rippling will probably become more apparent with time. Saline implants ripple more, and also settle more with time due to the 'water hammer' effect. Silicone gel implants are softer, don't settle as vigorously, and is more difficult to feel rippling.
Looking at your photos, your right inframammary fold has been more significantly lowered and the implant is sitting lower than the left implant. This is subtle, and not a major reason for your rippling. I believe you are rippling because your implants are too big for your anatomy, and that's an issue regardless of the type of implants you have, saline or silicone.
What to do going forward is a decision you and your surgeon will have to make. Your current result is very nice aesthetically, but with descent of the inframammary fold on the right and rippling in both breasts. There are good reasons to do nothing at this point and wait, following up regularly with your surgeon. There are good reasons to forge ahead with a revision: smaller implants, repair of the fold, change to silicone (if they are saline now), and posible reinforcement of your implant pockets with acellular dermal matrix. That's an awful lot for some one who really doesn't have 'big' problems. BTW, this is not a technical error by your surgeon, and he is not financially responsible if you choose to move forward with a revision surgery.
My recommendations have been made based on your photo and brief description of your problem, and these recommendations might change after a proper history and physical examination.
Best of luck!
Tissue stretches with time.
Your result is fine and not worth any revision at this time. Rippling often gets more visible with time as your tissue thins and stretches. Cohesive silicone gel implants ripple less often but this still occurs frequently when moderate to larger implants are used. This problem is most visible along the lower half of the breast as the implant is not covered by muscle and thicker tissue. How much and how quickly your tissues will stretch and how this will affect your shape and rippling is not possible to predict. In general the problems get worse over time. These issues are much less commonly a problem in patients with thicker and when cohesive gel implants are placed in a sub-pectoral location.
Revision surgery involves risk and expense so should only be done when the issues are more serious. Often an improved outcome is possible but your tissues will be permanently thinned and streteched. I hope that your rate of change is very slow and you are not faced with a more urgent need for revisional surgery that may involve moving to smaller implants and may require a breast lift for optimal shape results. Although your breast look fine at this time and you may be satisfied with the size that was achieved, choosing moderately large and highly projecting round implants in your case is slowly overwhelming your tissues ability to support and camouflage the implants. Women that choose smaller implants achieve less dramatic short term enhancement but have a more predictable long term maintenance or their results.
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Rippling and bottoming out
Your rippling may get a little worse over time but as far as bottoming out, the current inframammary fold will likely stay put. You have a very nice result, not perfect, but very nice. The enemy of very nice is better. I would get some great bras and be happy. If issues occur in the future, deal with them then.
Lisa Lynn Sowder, M.D.
Breast implant rippling over time
The amount of ripple seen over a breast implant will depend on the amount of natural breast tissue to cover, and the position of the pocket. Generally the tissue and skin will relax and conform to the implant over the first year, and then become fairly stable over many years. Your implants are not bottomed out, and we would think that there is little reason to believe that they will become so. My vote is to avoid revision and go with your result which is quite good until the present implants have worn in ten years of so.
Best of luck,
In the normal arms down pose, their is little to no bottoming out. Rippling as you say usually develops as the tissues thin out. They can get worse with time.
Bottomed out breasts
The view that matters most is the one with your arms down. The arms up ones just create distortions. In the arms down view, your "bottomed out" breast is very minor. It shouldn't get any worse. The rippling is from being thin (are you also saline?). Don't lose any body fat and they shouldn't get worse. If they are saline, you might need to change to gel and at that time get the pocket tightened up.
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
- Heavier and larger breasted women
- Using a highly cohesive form-stabile silicone implants (gummy bear)
- Smooth implants
- Smaller implants
- Submuscular placement
Rippling with breast implants
If you decide on a revision, you may want to consider adding a dermal matrix sheet between the breast and the implant where the rippling is visible to blunt the impression of the implant on the overlying skin. This will also address the bottoming out. I would visit with a board certified plastic surgeon to discuss your options in more detail.