I had BA 7 weeks ago w/ 350cc saline. I am relatively thin and have begun to notice rippling on one breast in the cleavage area. The rippling is not major, but I am concerned it is going to continue to get worse. Does rippling continue to develop? Is there anything I can do from stopping it or any activities that could make it worse? Thank you.
Once You Notice Rippling in Breast Implants, Will It Continue to Get Worse?
Doctor Answers 9
Breast implant rippling?
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.
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 visible wrinkling can be concealed with fat grafting
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!
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Breast implant ripples
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.
Rippling after breast implants should not get worse.
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.
Breast Implants and Rippling
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.
Factors that are associated with increased rippling include:
- Traditional Saline implants (IDEAL® Saline implants less likely)
- Textured implants
- Large implants
- Thin patients with low BMI
- Implants placed above the muscle
- Prior history of rippling
- Heavier and larger breasted women
- Using a highly cohesive form-stabile silicone implants (gummy bear)
- Smooth implants
- Smaller implants
- Submuscular placement
Rippling with breast implants
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.