Had 250cc implants placed, I see minor rippling. What can be done to blend/fix right implant and asymmetry? (photos)

Hello,
Your photos are woefully inadequate, but they suggest capsular contracture in the breast that is circled. If you don't trust your surgeon, get a second opinion from a few ABPS certified/ASAPS member surgeons who specialize in revision breast surgery. Best of luck!

When then breast sizes are close, using the same size implants is usually better in the long term. Over time, symmetry tends to improve. In cases when the size difference is a cup size, then it worth trying to even out the volume, and there are several ways to do this, including different sized implants or reducing the breast tissue in the larger breast.You did not state how far out from surgery you are. If it is months, then be patient, it is too soon to tell. If it a year, go over specifically what you would like corrected. Adding another 25 ccs may or may not be the answer. You may want to consider getting several opinions, in person, before proceeding.

As the previous surgeon stated, without actually examining you in person, it's challenging to give you advice on implants.  As far as you knowing exactly what is needed volume-wise, I would caution you on telling you surgeon the exact size especially if he/she is using sizers.  Let them decide in the OR what works best because the sizers will let them identify this far better than outside of the OR. At this point if you are not happy, get a second opinion from another Board Certified Plastic Surgeon but make sure that they specialize in breast surgery. I hope this helps and wish you the very best!Warmest regards,Gregory A Buford MD FACSBoard Certified Plastic Surgeon and Author

Dear amarama,I understand your concern. However, without a proper assessment it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment. Only after thorough examination you can get proper recommendations and advice.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

You may have thin soft tissue coverage in the area of concern, or your muscle may be more released in that area, or you may have a minor capsular contracture. All could be contributors to perceiving rippling or thinness of the coverage over your implant. The minor size difference issue is probably a red herring and not related to your concerns. In fact, 25cc is often barely perceptible. This has more to do with some asymmetries in your pockets and the interface between the tissues and your implant on each side. Correction might require fat grafting, dermal matrix products or other techniques to try to "shroud" the involved implant; if capsular contracture is present, capsulectomy and a new pocket may be necessary. Exam in the office is the place to start for evaluation.

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-person consultation with board-certified plastic surgeons who can demonstrate significant experience helping patients with this type of revisionary breast surgery will be your next best step. Best wishes.

Its difficult to tell what might be going on in the photos you posted. It sounds like you might have formed a capsule on one side. This is something that could be diagnosed during an examination. Rippling happens for a few different reasons: saline ripples more than silicone, above the muscle ripples more than below, and patients with very little breast tissue tend to have more rippling. Depending on what is causing your issues, there are a variety of treatments that can be employed to dramatically decrease the amount of rippling. Fat grafting can also be used to thicken the skin and to reduce any asymmetry.Best,~Dr. Sieber

With thin tissue, ripples may show with saline implants. You could have fat grafting, dermal graft placement, or exchange your implants for gel. Also, your implants could be placed behind the muscle for better coverage. I would suggest going back to your surgeon and discussing all your concerns.