Can I Get a Better Result with a Revision?

I am a very thin mother and I have thin skin and visible ribcage. In May I hac BA with Natrelle implants 360MM placed subglandularly. Breast widths 12.5 and 12cm. The implant chosen is 13cm wide. My smaller breast has a visible protrusion in the cleavage ever since healing. I am told it is rippling and I attempted fat grafting but it failed. Is the implant too llarge for my breast squeezing it causing a knuckle? It is definitely not lying flat. I can feel the borders laterally and I can feel rippling.

Doctor Answers 10

Fixing Breast Implant Rippling &Wrinkling

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If you're very thin or lean, any type of #implant can display some #wrinkling.  However, #positioning under the muscle may help.  Silicone implants do better than saline in this case. Also, adding a mesh (i.e. #ADM or similar) can help. Also, replacing with smaller implants, skin #tightening and #capsulectomy may also treat #rippling or #wrinkling.Your procedures should always be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery. You will then greatly improve your chances of getting the result you desire, and, without the need for further revision surgeries. It is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.

Breast surgery revision

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If you have rippling, fat can sometimes cover the rippling. If this does not work sometimes using a thick piece of strattice will soften the rippling. Best to be seen in  person to determine this.

Revisionary Breast Surgery Helpful?

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Thank you for the question.

Although I cannot provide you with precise advice without direct examination and a full communication of your goals, some general thoughts may be helpful to you.

 For patients with your body type (very little soft tissue coverage for the breast implants),  sub muscular ( dual plane) breast implant position works best when it comes to rippling/palpability of the breast implants.  It is possible that you will benefit from removal of your current breast implants and reaugmentation  of breast implants in this plane.  The use of acellular dermal matrix ( allograft) should also be considered.

 Again, in person consultation will be necessary to provide you with specific advice.

I hope this helps.

Conversion submuscular might help the problem of visible rippling.

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The incidence of visible rippling is the same with silicone gel implants above or below the muscle with the exception of very thin women.  In this case, placement below the muscle might add some advantage.  Nevertheless, it's a judgment call.

Larger breast pocket needed, Revision is necessary.

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From the description of the size of your implant relative to the size of the breast pocket, it seems quite obvious that the pocket was not made larger than the implant, hence the capsular contracture and folding of the implant. A good rule to follow in doing a Breast Augmentation is to make the breast pocket at least 2 to 2.5 cm wider than the perimeter of the implant's circumference with a wider spread of the pocket laterally so the implant has a chance to fall to the side as a normal breast would when you are lying down, instead of being stuck upright and immobile on the chest. If you do not have enough chest width then a smaller implant would be necessary.

Stanley Taub, MD (retired)
New York Plastic Surgeon

Breast Revision Procedure

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An in-person consultation is necessary to determine what kind of revision procedure could help you get the results you are looking for.  From your description, you might need an implant with a smaller diameter to reduce the rippling and implant visibility you are experiencing.  Choose a board-certified plastic surgeon that has extensive experience with breast revision procedures, not just breast augmentation, as there is a bit more work involved with a breast revision.

Palpable fold in a subglandular implant

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Without an examination it is difficult to determine your exact implant problem but in general if the implant is wider than the pocket then a crease can develop.  These creases are usually more noticeable with saline filled implant but can be a problem with gel filled implants especially if there is a lack of soft tissue coverage over the implant.  It is possible that you need a smaller implant base diameter placed in the submuscular position.  

Revision of Breast Augmentation Should Improve Your Look

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I have treated many patients with the problem you describe. I think you would likely be significantly improved by transitioning the implant to the submuscular plane and possibly using a smaller implant.

Site Change and Downsizing for Revision Augmentation

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In order to have less implant visibility in thin patients with small preoperative breasts, most surgeons will recommend placement of the implants below the pectoralis major muscle. The other thing that is recommended for less implant visibility is the placement of implants that have diameters that are less than the width of the patient's breast. So, in order for you to look more natural with less implant visibility is to change the location of the implant (Under the muscle) and to choose an implant that has a base diameter that is smaller than your breast width.

Thank you for your question. Best of Luck!


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Sorry to hear about your problem. Being that you are a very petite lady with thin skin. It is very hard to give adequate advice without and exam or a picture. You should get a second opinion. Maybe getting silicone and a little smaller can help. Once again I can’t be more accurate without an exam. Good luck.


Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon

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.