How to Fix Breast Rippling 2 Years After Breast Augmentation?

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

Thank you for your question.Unfortunately, rippling of your breast implants can occur following a breast augmentation procedure and is often related to a number of factors.  These factors can include: the placement of your breast implants in relation to the chest muscle (above or below the chest muscle), the amount of breast tissue coverage, implant type (saline vs. silicone and profile type), and, specifically with saline implants, the degree of implant filling.  Correcting the rippling of your implants does require a surgical intervention that often includes an implant exchange from saline to silicone gel implants and the use of an acellular dermal matrix (such as Strattice) to help thicken up a patients thinned out skin.  If you are concerned with breast implant rippling I would recommend following up with your operating surgeon to discuss your concerns.  I hope you find this helpful and best of luck!

Thank you for your question. Rippling can be seen when the surface of an implant shadows through the tissue, often found where the breast tissue coverage is thin. Some implant styles are more prone such as an overfilled saline implant. Others are less prone such as a shaped silicone implant. So one approach is to change an implant to one that is less prone to rippling. Another approach would be to add some thickness to the breast tissue. This can be done by fat grafting where fat is carefully layered between the skin and the implant. Another is to add a dermal matrix sheet between the breast and the implant where the rippling is visible to blunt the impression of the implant on the overlying skin. If you notice the rippling soon after surgery, I often recommend waiting until around the six month mark as your breasts may continue to change during that recovery period. I would visit with a board certified plastic surgeon to discuss your options in more detail.

Breast augmentation has extremely high satisfaction
rates but occasionally rippling can occur following this procedure. This can
occur with either saline or silicone breast implants. Several factors have been
associated with rippling following breast augmentation. These include saline
implants, large implants, thin soft tissue, and placement of implants on top of
the muscle.

The potential for rippling can be decreased in several
ways. It’s important in high risk patients to avoid using implants that are
large relative to the patient’s native breast tissue. Firmer implants such as
silicone and adhesive gel implants can also decrease the potential for this
problem. Submuscular placement decreases rippling by increasing the soft tissue
coverage over the implants. Surgeons should avoid over dissection of the pocket
and avoid implants that are winder than the patient’s breast tissue. Finally
over filling the implant when using saline may help to minimize rippling.

Despite these maneuvers, rippling occasionally may still
occur. It’s important to realize that in the vast majority of patients rippling
isn’t a problem and even when it does occur most patients are still very happy.

If you’re concerned about rippling
following breast augmentation consultation with your plastic surgeon is appropriate.
Depending upon the specifics of your previous procedure your surgeon should be
able to formulate a treatment plan that’s appropriate for you.

Rippling is very difficult to fix, even with surgery.  It is not possible to fix rippling without surgery.

You best opton to diminsh rippling of the implant is to consder the use of high profile silicone getl filled implants.

Rippling requires surgery to fix - the best procedure depends on the type of implants you have, how thin you are, and the placement of your implants. Best to go back to your surgeon to discuss your options.

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.

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. Patient weight gain (if possible) may also be helpful.
 
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 occurs when the overlying breast tissue is thin.  There are several ways to diminish the rippling: 1) Placing the implants subgladular pocket to submuscular pocket, 2) Overfilling of the saline implants although this will make your breasts fill firmer, 3) Switching the saline implants to silicone implants, 4)Fat grafting into breast tissue.

Different options available to fix rippling:1. Change implant to gel if you have saline.2. Change pocket to under the muscle.3. Use alloderm or similar material.4. Fat grafting between the capsule and the skin.Your plastic surgeon will be able to choose the best option for you. Best of luck!