I'm 6 Months Post-op and Slightly Bottomed Out. Rippling Starting to Appear. Will It Get Worse with Time?

Hello Petitegirl,

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!

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 implantsLarge implantsThin patients with low BMIImplants placed above the musclePrior history of ripplingFactors which are less likely to have rippling include:Heavier and larger breasted womenUsing a highly cohesive form-stabile silicone implants (gummy bear)Smooth implantsSmaller implantsSubmuscular placementOnce 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.#rippling#breastaugmentation

Thank you for your question. Rippling can be seen when the surface of an implant shadows through the tissue, often found where the breast tissue coverage is thin. It can happen in one or both breasts. If you are beginning to bottom out, then the breast tissue on affect side is starting to thin.  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.

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.

Dr. Mosher

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,

peterejohnsonmd

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.

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. 

 

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.

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.