Will I get rippling from 800cc implants over the muscle?

Question

Hi I'm looking to get 800cc implants but have been told my surgeon does not do under the muscle. I want under the muscle because I have had a child so my skin is thin and I worry that if I get large implants over the muscle then I will end up with rippling. Will this happen? I have another appointment with him on Monday if he refuses to do under the muscle should I look for another surgeon? Thank

Christopher J. Davidson, MD, FACS · Answer

Although surgeons differ in their approach and technique, I almost never place an implant on top of the muscle.  The reason behind this is that I think that the look and feel of the implant is much less good/natural as compared to under the muscle augmentations.  Furthermore, you are more likely to experience a capsular contracture and visible rippling when the implant is placed above the muscle.  Although this is only my opinion I suspect that in the Boston area the vast majority of surgeons place the implant below the muscle.  Best of luck.

Nelson Castillo, MD · Answer

Thank you for sharing your question.  800cc implants are very large and when placed above the muscle would likely show rippling in most patients.  I would counsel you to see a series of ASPS board certified plastic surgeons to have second and third opinions.  Hope this helps.

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.
  
The best way to determine implant size is based on chest wall measurements that fit your body.  Once we determine that we can choose the profile based on what you want or need to achieve.  
  
Implants under the muscle, there is less risk of capsular contracture.  Anatomic implants tend to give a more natural shape with more nipple projection.
  
The best way to assess and give true advice would be an in-person exam.  Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.
  
Best of luck!
  
Dr. Schwartz
  
Board Certified Plastic Surgeon
  
#RealSelf100Surgeon
  
#RealSelfCORESurgeon

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The best advice you can
receive is from an in-person consultation.  It is very unusual if your surgeon is board-certified by the American Board of Plastic Surgery that he/she would not be able to place implants under the muscle.  There are several advantages and disadvantages to over vs under the
muscle.  Under the muscle has the advantage of lower capsular contracture
rates, less risk of rippling, and better visualization with future mammograms. 
Most patients say that under the muscle also has a more natural look and
feel.  The size, shape, and profile of the implant is based on your
desired breast size/shape, your chest wall measurements, and soft tissue
quality.  This decision should be based on a
detailed discussion with equal input from both you and your
surgeon.  This entire surgery can be
performed with a small incision technique.  Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

David R. Alfonso, MD, FACS · Answer

Those are likely too big and should definitely not be used in augmentation especially above the muscle. Seek out another surgeon for a second opinion

Edward J. Bednar, MD · Answer

it is highly unusual for a board certified plastic surgeon to be only placing implants above the muscle.  I would gather more opinions before you move forward with your surgery.

Michael J. Weinberg, MD · Answer

Thanks for this question.The decision to go above or below the muscle depends on several factors. It mostly depends on how much breast tissue you have to start off with.If you have "very thin skin", then you are not be a candidate for an implant above the muscle, because of obvious rippling and capsular contracture. This would especially be the case with excessively large 800cc implants.I

Ross Blagg, MD · Answer

Hi,Most surgeons place implants under the muscle as there are several advantages. One is less rippling. Another is a decrease risk of capsular contracture. If you have very little breast tissue, your risk of rippling is higher since there won't be much to conceal the implant. If your surgeon states he will not go under the muscle, I would seek another opinion and ensure that you are seeing a properly trained plastic surgeon. Any plastic surgeon should be very comfortable placing an implant under the muscle. All the best,Dr. BlaggAustin, TX

Pouria Moradi, MBBS, FRACS · Answer

Thanks for getting in touchThere are so many alarm bells in this enquiryThe most serious being that your surgeon doesn't do under the muscle augmentations.Surely that can't be true. If it is, I wouldn't bother having a 2nd consultation I would look for another surgeonOn rippling.All implant ripple...round more than tear drop because of the softer gelEspecially large implants.We try and go under the muscle so that in the thin and lean patients the upper border is camouflaged by the muscle, so you don't see the rippling.I hope this helps

Robert S. Houser, DO · Answer

first, that is a huge implant. Of course I don't know what you look like, but that implant really won't fit on anybody's chest for a first implant.  It is a set up for all kinds of problems in the future and rippling would be the least of your concerns.  Secondly, I wouldn't trust any plastic surgeon who states that they only put Implants on top of the muscle.  Although there is still some controversy about this, most board-certified plastic surgeon's use a dual plane approach which places at least the upper portion of the implant under the muscle.  I would scratch that first guy off your list and strongly reconsider the size of implant you were asking for.

Will I get rippling from 800cc implants over the muscle?

Answers (13)

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