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.