Redo Implants to Fix Wrinkles/Rippling?

Pao,

To treat implant rippling you can choose a more cohesive gel or fat grafting to add fat coverage on top of the implant.

at 5'7" and 123lb you're pretty skinny and therefore any rippling will be more visible than in a heavier patient.  Thus you have two problems:  an implant that is rippling, and skinny body that does not hide implant imperfections well.  To address the first problem, you can chose to go with a more cohesive (harder) implant.  It feels less natural but has less rippling.  To address the second problem, if you have any areas that can be used to collect fat  (at your height and weight that may be unlikely) fat can be injected under the skin over the rippled area to cover up the rippling.  It is a technique that is gaining a lot of popularity because of it's results.  However, once again, you need to have sufficient fat that can be used for this purpose.

Sincerely,

Martin Jugenburg, MD

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 implantsLarge implantsThin patients with low BMIImplants placed above the musclePrior history of ripplingFactors which are less likely to have rippling include:Heavier and larger breasted womenUsing a highly cohesive form-stabile silicone implants (gummy bear)Smooth implantsSmaller implantsSubmuscular placementOnce 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.#rippling#breastaugmentation

#BreastImplant Rippling in tall , lean womenRippling can be reduced with higher fill implants, #Inspira or saline overfilladding fat , #hybridbreastaugmentation,tightening skin.Fat, and ADM of some type i.e. #belladerm

If your implants are under the muscle, then switching to silicone is the simplest option, and will certainly help. I would go with the same size or larger.

The high profile implants have a lower tendency to ripple and I would possibly adivse the use of a 350 high profile silicone gel implant to minimize the visibility of the wrinkling. Fat grafting is an option but not without risks and I would advise proceeding with implant exchange first. 

Since you have rippling with saline breast implants, I would recommend converting to a silicone gel implant which has a lower incidence of rippling/wrinkling.  You can also decrease the size of the implant slightly as you are relatively thin and this will help.  Furthermore, you may need a synthetic skin (acellular dermal matrix) placed in between the implant and your tissue to help camoflauge the implant, this can be done with either Strattice or Alloderm. Hard to say exactly what you need without seeing you in person, but these changes should help.

Please consult with a board certified plastic surgeon for a comprehensive exam and review of your treatment options.

Best wishes,

Dr. Bruno

The issue at hand here is lack of soft tissue coverage over the implants. All implants wrinkle and fold to some degree- saline more than silicone.  Larger implants fold and wrinkle more than smaller ones.

Without the benefit of a photo or physical exam, my suggestion would be do downsize volume, switch to silicone implants, and consider acellular dermal matrix (like Strattice by LifeCell) covering to improve soft tissue thickness over the implants. You could also consider fat grafting, but in my experience, this is less reliable than Strattice.

All saline filled implants can get rippling along the edges. Soft tissue coverage is the key. As long as there is sufficient soft tissue to cover the edges of the implant you will be fine. Otherwise I would consider a gel implant. The long term fate of a saline filled implant is to round out the bottom of the breast as the implant is heavier than a gel.

Thank you for the question.
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.

Having discussed these issues,  PREVENTION of rippling/probability is of critical importance.

Much of the final “look” achieved after breast augmentation surgery  depends on several factors:



1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” and "feel" will be optimal.




2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.  Make sure you're working with a well experienced board-certified plastic surgeon.



3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.




4. The size and model of breast implant used may  make a  significant difference in the final outcome,  including the presence of rippling/palpability  of the implants.

 I hope this helps.

 

Rippling and palpability are related to the thin soft tissue coverage over the implant.  Yes, silicone may preduce these symptoms, and placing them under the muscle may help as well, but alloderm may be necessary to add additional coverage.