Rippling and saline implants
Because of your refusal to switch to silicone gel, which is a much better alternative for rippling than saline, I don't see that you have any options. If you are thin, it is difficult to camouflage the viscosity difference between your tissue and the salt water in the implant-thus the rippling.
An obvious option is to remove the implants and be done them. This would leave you with native volume which might be more of a problem to you than rippling. I would avoid "gimic" surgery to correct the problem. Operations of any kind carry risk and rippling, although unwanted, is not a health issue.
I hope things work out for you. You might want to reconsider your reluctance to use silicone gel.
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 implants
- Large implants
- Thin patients with low BMI
- Implants placed above the muscle
- Prior history of rippling
Factors which are less likely to have rippling include:
- Heavier and larger breasted women
- Using a highly cohesive form-stabile silicone implants (gummy bear)
- Smooth implants
- Smaller implants
- Submuscular placement
Once 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.
Thank you for the question.
Sorry to hear about your challenging history.
In regards to rippling of breast implants...
Palpability and rippling of breast implants may be related to several factors. These include the amount of soft tissue and breast tissue coverage over the breast implants, the position of the breast implants (submuscular versus sub glandular), the type of implants (saline versus silicone), and the degree of overfilling of saline filled implants. Generally, weight loss will extension weight any rippling/palpability of the implants. Deflation of the implants will also increase the rippling/palpability of the implant.
Correction of the rippling may involve further surgery including implant pocket exchange if possible ( sub glandular to submuscular), implant exchange if possible (saline to silicone), and/or the use of allograft to provide an additional layer of tissue between the implant and the patient's skin. Patient weight gain (if possible) may also be helpful.
I hope this helps.
Thanks for the question. Ideally, for management of lower pole rippling, you would be best suited with silicone implants. However, if you are averse to this option, a reasonable alternative would be to have Alloderm, Strattice, or a comparable tissue matrix implemented to line the implant pocket along the areas of the profound rippling. There is always the downside risk that this tissue matrix could become infected.
Additionally, tissue matrix tends to be fairly costly, especially if the areas of rippling are extensive. I would recommend consulting with your surgeon to review these alternatives more thoroughly thus allowing you to make the best possible decision to meet your needs and expectations. Best of luck.
Silicone or a tissue matrix like Alloderm
I agree that a change out to silicone would be your best option. Remember that the new silicone implants are more of a "gel" consistency and not a "liquid". Also, remember that your saline implant shell is actually made of silicone! For severe cases of rippling, you may inquire about Alloderm or other tissue matrixes that can be placed over the implants to hide the ripples internally. This is for severe cases that have not responded to other treatments.