Silicone implants placed in dual plane, rippling baldy for 4 years. Advice? (photos)

Implant rippling can be a difficult prolem to correct or improve. Patients a highest risk are those with little breast tissue and body fat. Reoperative surgery is necessary, with attention to restoring pectoralis coverage over the implant. The IMP HR is a textured implant, and changing to a smooth wall implant would reduce the problem. In severe cases, use of tissue substitutes such as acellular dermal replacements, may be necessary to provide thicker tissue coverage.

Rippling occurs to some extent with every breast implant. Treatment depends on the cause. If capsular contracture has occurred, this would need to be released. If the problem is thin soft tissue coverage, sometime an ADM can help. ADM may also be used to help raise the position of your breast implant, if the implant is too low. Implants with stiffer, more cohesive gel, can also be of benefit in some cases.

Best method for improving implant rippling is to use a highly cohesive implant, aka gummy bear implant, and also, to do fat grafting to the skin and subcutaneous tissue above the implant to add more covering.  I do a lot of Pre-pec breast reconstruction, and have zero rippling with those two methods (in combo with Alloderm usually).

Rippling is often the result of thin soft tissue coverage. This can be camouflaged with an ADM like Strattice and/or fat grafting.  As for the position of the implants, I would have to evaluate you in person to see if they are malpositioned now.  This can often be adjusted with a pocket repair. Good luck.

I am sorry to hear about your concerns after breast surgery. Although I cannot provide you with specific advice, some general thoughts may be helpful to you.  
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 implants.
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.  In your case specifically, based on the limited information, I would likely recommend revisionary breast surgery that includes  placement of the implants in the sub muscular position along with the use of acellular dermal matrix and capsulorraphy techniques to keep the breast implants higher on your chest wall.  Best wishes.

Sorry to hear about your rippling.  It's possible that your surgeon performed a "dual plane 3" procedure and the pec muscle retracted upwards leaving your implants basically in a subglandular position.  Regardless of the cause, the question now is what to do about it.  There are several options that you should discuss (preferably with more than 1 PS).  Fat grafting.  ADM placement (which is sheet of human collagen mesh).  Trying to put your implants under the pec muscle.  And finally, consider changing out to Allergan Cohesive level 3 implants.  The other manufacturers (Mentor and Sientra) also claim to have highly cohesive implants, but in my opinion (and I've tried them all), the Allergan implants work the best.  I get a lot of professional bodybuilders in my practice who want their implants over the muscle so it won't interfere with their workouts so I am one of the few docs that has a lot of experience with this.  Be sure to seek out a PS with lots of over-the-muscle experience.

To address your concerns an in person exam will be required. The photo of an MRI is not particularly useful as normal appearing implants may have a rippled appearance on the MRI and implant position relative to the pectoral muscle may vary. Newer cohesive breast implants as well as fat grafting are two methods to reduce rippling. If the implant is too low (bottoming out) you may require something called a capsulorrhaphy or a neosubpectoral pocket or a mesh to support a repositioned implant. Best of luck to you