Muscle Detached from Sternum From Breast Augmentation - Will It Get Worse over Time?

-Muscle detached from sternum (right side) from ba -Implant slightly bottomed out medially & inferiorly -I have saline (325 filled to 390) - Starting to notice rippling in my right cleavage where my muscle got separated.

I'm thin and worried that the 'exposed' implant in my right cleavage is going to show more rippling with time. Should I wait & see how bad it gets or should I get a revision now? Is it harder to fix if it gets worse? Results are fantastic but worried.

Doctor Answers 11

Breast implant rippling

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Your results are quite good and we should all be so lucky. Rippling is an inherent property of implants. Overfilling a saline implant (above the amount listed on the box) on the other hand can be unsightly & doesn't necessarily prevent the appearance of rippling. Although all implants have some rippling saline implants have the most and cohesive gel have the least. I do not believe your rippling is due to overdissection of muscle.

The rippling becomes visible from the outside when the implant has more of it and the tissue between the outside world and edge of the implant is thinner. That is why saline implants are usually placed under the muscle. Despite that rippling along the lower and outer edges of the implant are still a possibility because the muscle does not extend down to those areas. You probably have rippling on the upper part of the implant as well it just does not show because the tissue is thicker (the implant is also covered by muscle here).

The questions then are is this bad enough to do something about it and will it get worse with time. My personal opinion is it is not bad enough to do anything about it now unless it really bothers you. Will it get worse over time? Probably but that time frame could be quite long. My personal opinion is no breast implant patient gets only one operation and the time between operations should be as long as possible. If/when you get your next operation your best bets are probably switch to a cohesive gel implant and/or place an acellular dermal matrix to thicken the tissue in the lower inner quadrant of the right breast and make the rippling less visible.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Los Angeles Plastic Surgeon

Sternal muscle issue

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You problem is very, very minor.  You look lovely and I would make sure to wear a good bra when you are upright and forget about pursuing any revision.  If bottoming out and/or rippling get to be more of an issue as you age and gravity works on you (as it does on all of us), it may be worth it to look into revisional surgery.  You should be thrilled with your current result.

Lisa Lynn Sowder, M.D.

Ripple worries after breast augmentation

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It is very typical for breast implants to ripple or be felt where the muscle does not cover and hide the implant, particularly over the lower and the outside edge. Both saline and silicone gel can do this, saline perhaps more so. Also if the implant is full the edge may be seen on the lower inside edge where the muscle has been released to accommodate the implant. After several months the pocket and implant are stable and things tend not to get worse. Your results are indeed fantastic to stop the worry and enjoy.

Best of luck,


Muscle Detached from Sternum From Breast Augmentation - Will It Get Worse over Time?

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To directly answer your question is the first issue I wish to elaborate upon. In my opinion from the posted photos you do NOT have pectoral sternal over dissection or "SYMMASTIA". The photos demonstrate no midline connection. As for the issues present on your photos Dr George Marosan's post outlines in detail your issues and offers a great treatment plan. 

Breast augmentation

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The concern you have is barely  noticeable when your arms are down.  Lifting the arms can distort things. I would hold off.  Rippling often gets worse with time especially if you are very thin.

Muscle detachment from sternum following breast augmentation

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From you photos, I do not believe you have detached the pectoralis muscle from the sternum - a condition known as symmastia.  Your right implant does appear to sit slightly lower on the chest than the left but they are reasonable close to being symmetrical.  I would not suggest any surgical revision at this time.  Wear a good support bra may help if it has been a relatively short time since your sugery.  If the left capsule is tighter that the right, I would suggest left breast massage only.  This conservative approach may help improve the symmetry without further surgery.  Overall, you have a very good result, I would be careful not to charge into another surgery which may make matters worse and not better.

Rippling in cleavage after breast augmentation

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You did not mention how far out you are from the procedure.  The more recent the procedure, the more likely you may see additional changes over time.  As you stated the "results are"fantastic", you would benefit from following your appearance closely along with your surgeon to determine when or if any intervention (there are several potential options) should be performed.


Rippling in cleavage after saline implant augmentation.

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Thank you for the photos.You are asking two questions: 1. Will the bottoming out get worse over time and 2. Is the rippling in the cleavage on the right side secondary to muscle detachment? You do show some bottoming out especially with your arms elevated and the right side is worse than the left side. This can be secondary to overdisecting the pocket inferiorly and also that your thin tissues are not able to support the weight of your implants. You would need to wear a good supporting bra most of the time to minimize this. Saline implants are overfilled by 25-30cc as recommended by the manufacturers.Your implants are filled beyond the recommended volume. This can lead to scalloping at the edges which you note as rippling. Since your tissues are thin, this is more visible. Over time this can get worse as your implants keep stretching the implant pocket. A simple solution for this would be micro fat grafting this area to get more tissue coverage. Another option would involve more surgery, by placing tissue matrix inside the capsule where the rippling occurs and replace your saline to silicone gel implants. You need to discuss this with your plastic surgeon and be examined to determine the best outcome in the long run. Good luck.

Breast Implant Malposition?

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Thank you for the question.

Based on your description you may be experiencing medial  (towards the cleavage)  implant malposition.  this situation along with the rippling can be corrected using internal suture technique (capsulorraphy)  along with  allograft  (acellular  dermal matrix).

Generally speaking, one of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla).

Although you are not experiencing symmastia,  you may still benefit from  repair of the implant pocket immediately and with a  possible exchange  to silicone gel implants.

I hope this helps.

Visible edges of a breast implant

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I agree that the muslce was elevated off of the sternal attachment and it will likely get worse with time due to the muscle that is still intact pusing and the stretching of the skin from the implant. An attempt at getting the skin to reattach using external pressure can be done, but that will not reattach the muslce. Reattaching the muscle will require surgery and I feel fixing it sooner rather than later will make the repair less of a challenge.

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.