BA 5/2012 Natrelle Teardrop Subglandular. Second Opinion For Visible Knuckling? (photo)

I had BA in May 2012 with natrelle teardrop implants 360mm subglandularly. Since healing I have palpable folds and edges in both breasts. Right breast is worse and has a visible knuckle in cleavage area. Fat grafting was done and did not help. Now my surgeon wants to reopen my pockets and enlarge them mesially and replace same implants under local anaesthesia. I am concerned this may not work and also about rotation since there will not be a new pocket to adhere to. What do you recommend?

Doctor Answers 10

Subglanduar implants

Dear Amy284,

     Your issues stem from the subglandular position of your implants.  It is rare that implants do well in front of the muscle.  It is a misconception that the new gummy bear implants cause less rippling.   They may cause less number of ripples, however, the ones that do form are much more severe than in smooth implants.  Your only solution that would work both in the short term as well as long term is to convert your implant position to the submuscular space.  I recommend the smooth round silicone gel implants.

Good Luck,

Ary Krau MD FACS


Miami Plastic Surgeon
4.8 out of 5 stars 319 reviews

Treatment of Visible "Knuckling” of Breast Implant?

Thank you for the question and pictures. Although it is not possible to give you precise advise online, generally speaking patients in your situation may benefit from breast reaugmentation  in the sub muscular position and/or the use of allograft material.

 I would differ from your plastic surgeon in that I would not suggest additional dissection in the sub glandular position;  this plan will expose you to additional problems with rippling/visible “knuckling” of the breast implant.

 I also share your concerns ( generally speaking) about the use of “teardrop” breast implants.

 You may find the attached link helpful as you do your "research” about breast implant revisionary surgery.

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Visible Knuckling

I would advise replacing these in the submuscular position with smooth round gel implants. The alternative, which may be more expensive, would be to cover the rippled area with Strattice, an acellular dermal matrix. I concur with your concerns about the offered solution being unsuccessful. 

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Ripples in my implants.

Thanks for your question.  I think you have a few options.  The textured implants can cause rippling.  I agree that a smooth round implant may help.  Also you may want to change the implant out to a submuscular position.  Also the new gummy bear implants may be an option.  They can be placed in the same position of your current implants.  They may be the simplest option.  Hope this helps.

Shaun Parson, MD
Phoenix Plastic Surgeon
4.8 out of 5 stars 46 reviews

BA 5/2012 Natrelle Teardrop Subglandular. Second Opinion For Visible Knuckling? (photo)

I would replace them with smooth round implants

If you are very satisfied with your current implants and wish to keep them ,then you may want to consider dermal grafting or mesh

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Teardrop Implants in Subglandular Plane

    The rippling can be improved by submuscular placement, fat grafting, the placement of a dermal matrix, switch to a smooth silicone implant and appropriate pocket dissection.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Second Opinion For Visible Knuckling?

Visible rippling is doe to thin tissue. We generally place implants under the muscle for better coverage and to hide potential wrinkling and rippling from being visible.  Saline implants show rippling more than do not say which you have. Textured implants may, depending on type (and certainly textured saline), show rippling more than smooth, and since you say you have teardrop implants those are always textured.  I think you should consider having your implants placed under the muscle if your tissues are thin enough to show implant wrinkling.

Robert M. Grenley, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 87 reviews

BA 5/2012 Natrelle Teardrop Subglandular. Second Opinion For Visible Knuckling?

What is being demonstrated is the risks of above muscle implant placement. Your surgeon tried to correct with fat grafting. Next step is changing the placement to below the muscle. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Implant issues

You are seeing visible ridging of the implants. Sometimes placing the implants under the muscle can help.  Also strattice may be a reasonable choice to camouflage the implant edge.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Visible implant edge

Are the two photos before and after fat grafting?  The second photos seem to hide the knuckle.  Here are some other options to discuss- what about partial subpectoral coverage?  What about a sheet of acellular dermis?  Each of these have their own pros and cons.

D`Arcy Honeycutt, MD
Bismarck Plastic Surgeon
4.7 out of 5 stars 22 reviews

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.