Once You Notice Rippling in Breast Implants, Will It Continue to Get Worse?

Once You Notice Rippling in Breast Implants, Will It Continue to Get Worse? The answer is usually yes. However, I have a few patients that are aware of rippling with as little as 5 lb wegiht loss but notice that it is less visible when they put the weight back on.

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. 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. 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.Should the rippling persist, there are several approaches to address this:  One 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.I would follow-up routinely with your plastic surgeon to monitor your progress and discuss options should the need arise.

Larger implants tend to wrinkle more, especially under thin soft tissue coverage. I've treated a few women with visible implant wrinkling using fat grafting in the sub-cutaneous plane. This is typically a low-volume grafting procedure- 50-60 cc per breast has worked in the past. Other options include very expensive dermal graft products like Strattice or Alloderm. Fat is free!

Thanks for posting this question. Use of ADM (natural dermal substitute) and high profile silicone gel implants under the muscle are the best fixes for rippling after augmentation. Rippling will not resolve without surgical intervention. Hope this helps.
Good luck.
Dr B

Thank you for the question.

Unfortunately, there is no way of knowing in your specific case whether the rippling will change with time.


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.

If you are seeing rippling at seven weeks, you will probably see more as time progresses. Some use fat grafts to camouflage and others use Alloderm.

It may continue to get worse, or this may be as bad as it gets.  Unfortunately, it is not possible to predict.  I would guess it will get a little more prominent, as swelling continues to resolve.

The sad limitation of ALL breast implants, both saline and silicone gel-filled, is that they all ripple when placed upright on their sides (IE the way the sit in you). Saline implants ripple MORE than silicone gel implants do. This is THE reason why most Plastic surgeon prefer to use smaller breast implants which can be adequately covered by the woman's own breast tissue, masking or softening these ripples.

Although practically any implant can theoretically be placed into almost any woman, there is a huge variability in the amount of soft tissue available to cover the breast implants and thereby a limitation in which tissues can be used, with good ripple-softening / covering results.

As we age we lose fat and out tissues thin and attenuate. Pressure from the implants result in further loss of breast tissue resulting in the uncovering of the underlying implants and their ripples. This means that with time the appearance of the ripples would gradually worsen.

In the future, you may need placement of either AlloDerm or Strattice between the implant and the skin OR fat grafting in this interface to try and thicken the interface between skin and implant shell.

Hi.

We seldom use saline breast implants, specially in thin women,  because they are much more prone to rippling, specially if they are not overfilled.  The good news is that the rippling is often stable, and does not get worse.  Your activites have no impact on rippling.