Rippling on New Silicon Implants? (photo)

Question

Had saline implants for over 25 years, replaced them with Silicon 4 months ago under the muscle once again. I am 5'7 and weight 128 pounds, very thin build. I'm told due to my build and thin skin, the rippling that I am experiencing with these new implants I must live with or consider the gummy bear implants or add more skin which I will not do. Somehow I think if I were to go larger to perhaps 650 + cc versus the 500cc, I would eliminate the ripples as the implant feels loose inside. Thx

Richard Baxter, MD · Answer

First let me advise you to not go bigger, that will often make the type of ripples shown in the picture (traction ripples) worse. You did not say if the implants are under the muscle, which often helps the upper part of the breast. High-profile implants may be more associated with traction ripples. Another thing to consider, somewhat paradoxically, is to add more support from below to hold the implant up. The best way to do this is with an acellular dermal matrix material such as Strattice. (ADM's can also be placed to add coverage over the upper part.)

Jed H. Horowitz, MD, FACS · Answer

Rippling of #saline implant is unlikely a serious issue. If you are 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. Smaller implants, skin #tightening and #capsulectomy may also treat  #rippling or #wrinkling. Be sure to select a plastic surgeon who is #board-certified and has a great deal of experience with breast #augmentation and the incision type, #implant placement, and implant type. If the implants are ruptured or more than 10 years old, consideration should be given to replacement.  Plastic surgeons who have specialized in breast surgery and cosmetic surgery are suitable to perform your breast augmentation. Aside from checking board-certification, 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.Typically, it's best to wait 6 to 12 months depending on the reason for #revision.  Matters such as sagging or drooping  and size change will not improve with time. As with all cosmetic surgery, results will be rewarding if expectations are realistic. With any surgical procedure, there are some risks which your doctor will discuss with you during your consultation.

Young R. Cho, MD, PhD · Answer

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. It can happen in one or both breasts. 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.

Steven Teitelbaum, MD · Answer

Your situation is unfortunately all too common: very large implants in a very thin woman.  Whenever the tissue is thinned and stretched, inevitably there will be some degree of rippling.My bet is that your implants are not behind the muscle.  Though you may have been told that they are, my bet is that the left slipped in front of the muscle.  If so, the implants should be put back behind the muscle and an ADM such as Strattice should be used to thicken the tissue and hold the muscle down.  If they are in front of the muscle, thickening your tissue with Strattice is also an option.I've used gummy bear implants for over ten years.  They can help in this situation, but understand that fundamentally you have a problem in tissue thickness and the first priority in remedying it is therefore to thicken it.The gummy bear implants do tend to ripple less. The Allergan Natrelle 410 is the most ripple resistant. However it has a teardrop shape.  If a teardrop implant rotates then it creates a deformity.  That is a rare problem when the tissue is tight, but may happen more often when the tissue is loose.  They also typically don't give the right shape in a breast such as yours.I believe the best implant for patients in a situation such as yours is to use the Sientra Textured Round implants because they have a cohesive filler and the implant shell is maximally filled, thereby allowing for less rippling than many other implants.Your problem is tricky.  Understand that there is no simple solution because there are a number of factors that are contributing to this problem.There are also sections on gummy bear implants.

Steven L. Ringler, MD, FACS · Answer

I am sorry that you are still having problems with wrinkling, but I do not think a larger implant is the answer. Most likely your new implants were placed in the original implant pocket. For patients who are very thin, this may often result in persistent wrinkling. The best solution is having the implants reposition behind the original pocket or adding a dermal matrix for additional coverage. You should discuss this with your surgeon or get another opinion from one with extensive experience in revisional breast surgery. Good luck.

Tom J. Pousti, MD · Answer

I am sorry to hear about the problems you are having. Based on your description and photograph, you may be a good candidate for the use of acellular dermal matrix;  the use of this material ( placed between your skin and the underlying breast implant) may be helpful to treat rippling. In my practice, I have used this material for this purpose with good success.  I hope this, and the attached link are helpful to you as you learn more about revisionary breast surgery.  Best wishes.

Barry L. Eppley, MD, DMD · Answer

By appearance and history it appears you have too much skin (soft tissue) for the existing size of your breast implants. The rippling you feel is more of your skin that is not adequately expanded over the implants rather than the rippling of the implants per se. Increasing the size of the implants may provide some improvement but is not the complete answer. A dermal matrix to provide better support and tissue thickness between the implants and the overlying soft tissue is likely also needed.

Steven Wallach, MD · Answer

If you have rippling with silicone, then you probably could benefit from Strattice placement to camouflage the rippling.

Jourdan Gottlieb, MD · Answer

Two assumptions I will make--these appear to be submuscular, and are without evidence of capsular contracture.If I am wrong, the likeliest contributing factor has been so identified.

	 

	The likeliest "cause" is the thinness of the cover of skin and muscle over the implant. Larger implants are not likely to solve this, and may add to the problem by making it present on both sides.

	If this bothers you enough, adding soft tissue coverage with an acellular dermal matrix (Strattice) offers the likeliest chance of improvement.

	Thank you for sharing your course and these photos. All the best.

Rippling on New Silicon Implants? (photo)

Answers (9)

More Breast Implant Revision Questions

Wanting a Smaller Implant Exchange: Will I Need to Get a Lift As Well? (photo)

Symmastia Repair and Life After?

What Should I Do to Add Volume to my Upper Breast?

Breast Implant Exchange. Do I Need a Lift? (photo)

Is It Normal to Pay for a Revision 6 Months After Breast Surgery?

Will Silicone Gel And/or Expanders Allow Me to Have Up to 1200cc Silicones? (photo)

WE SEND PRETTY
EMAILS