Hello, I had breast reconstruction on Oct 19 2012. I had a nipple sparing mastectomy followed by expanders followed by round silicone Hp 600cc implants. I have rippling on the top/cleavage and on the sides below my armpits. The size and shape are wonderful. The rippling bothers me. When I stick my chest out the ripples disappear. What would be necessary to hide these ripples? Fat transfer? Revision with alloderm? Which is the better option? How soon can I do that? Would insurance cover?
Reconstruction Rippling with Silicone?
Doctor Answers 4
Rippling following implant reconstruction
You describe a very common problem. The rippling is a function of the traction of the weight of the implant pulling against the capsule and transmitting to the skin. Fat grafting may help mask this as well as placement of alloderm in the superior poles. Another strategy is to tighten the lower and lateral poles of the capsule to offset the weight of the implant. You may be looking at a combination of all of the above. As far as insurance coverage, it should not be an issue as you are dealing with breast reconstruction. As far as timing, I am a little confused. Did you just complete the tissue expander to implant exchange last week? If so your surgeon will want to wait a few months to allow the implants to settle into their new pockets and for all of the postoperative edema to resolve. Congrats on your reconstruction and victory over breast cancer! I hope that you will find satisfaction and joy with your new breasts once the reconstruction is complete.
Rippling can be fixed
Strattice, an implant that is similar to alloderm, works very well for your kind of case. The advantage of the strattice is that it comes in sheets that are ideally shaped for placing around an implant. If there is any rippling remaining, fat grafting will usually resolve any remaining ripples.
Correction of implant rippling with Alloderm
Alloderm (ADM) grafting is usually the "go-to" option for concealing rippling after breast reconstruction with implants, because it adds both coverage and support. Some fat grafting may help too but sounds unlikely to work by itself from what you describe. Another possibility that might be considered in addition to Alloderm is to use form-stable implants, which have a firmer gel. These are available from Sientra and probably soon from Mentor and Allergan. They may not feel as natural though.
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Rippling of implants
Rippling after mastectomy is due to the thin soft tissue coverage over the implants. Sometimes fat grafting or ADM's can help add another layer of coverage.