Will Rippling on the Inner Side of the Muscle Disappear?

2nd BO after 7 months due to implant flipping. The PS told me he would try a dual plane procedure to cover the implant. I asked if rippling could be visible and he said that the top part is covered by muscle. Now after 7 days I have rippling on the inner part of the the L-breast and if feels as if the implant would only be covered by a very sheet of skin. Further pics and info on Realself JCSM.

Doctor Answers 11

Rippling on inner part of breast after breast implant

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You indicated that you had a dual plane breast implant surgery. This means that the top of breast impant is covered by muscle and skin, and the lower part is only covered by skin. This technique works well because it allows the breast implant to settle into a natural position. It is my preferred surgical approach. The inner aspect of the implant is only covered by skin and this is why yo are seeing visible rippling. I do not think this will get better...in fact it may get worse as time goes on. Yo did not indicate what type of implant you have, but usually smooth round silicone implants have the least amoutn of visible rippling. Switiching to this may help. Also, adding some fat or some dermal substitute like Alloderm or Strattice may also help.

Rippling on the Inner Side of the Muscle

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The rippling you are seeing may be a result of the #technique or placement applied during your surgery. Implant #rippling may be something that is felt by the patient or in very thin patients it may be visible. This usually occurs when there is not enough tissue coverage or when the implants are excessively large, relative to the patient’s breast and breast tissues. This commonly happens at the bottom but may also be seen towards the middle or on the sides; less commonly in the superior or top position. This occurs more frequently with saline implants and with saline implants.

In most cases correction of this problem will not be completely possible, however, improvement can be achieved depending upon the original cause of the problem. #Subglandular implants may require conversion to #submuscular position with creation of a new pocket allowing the muscle to minimize their problem. Patients with extremely thin tissues may require Acellular Dermal Matrix or other biologic fabric. Patients with textured implants may require changing to silicone implants.
Palpable implants are implants that can be felt by the patient. It is common to feel the under edge of the implant and on the side where the breast tissue and skin is the thinnest outside the pectoralis muscle location. On occasion, a small “knuckle” or portion of the implant can be felt. This may happen with weight loss, pregnancy, traumatic injury, and at times there is no specific identifiable cause. Adjustment of the pocket size, changing the implant, and adding support with Acellular Dermis or other tissue substitutes can help with this.

Breast Implant Rippling

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Thank you for the question and pictures.

Your situation may be improved with the use of allograft to cover the most visible/exposed areas of the breasts  involved with rippling/palpability of the implants. 

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.

   

Will Rippling on the Inner Side of the Muscle Disappear

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The visible ripple suggests that at that point the implant is probably only covered by the skin/breast tissue. In slim patients it can be challenging to provide enough cover over the implant and sometimes choice of the implant helps. It is unlikely for a visible implant to disappear on its own - you can try some fat graft to disguise it.

Anindya Lahiri, FRCS (Plast)
Birmingham Plastic Surgeon

Implant rippling

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Big implants in lean patients is always challenging.  My approach is to use smooth gel implants under the muscle the first time around and do some fat grafting is rippling occurs medially.  If the rippling is better with a little support from underneath, adding a sheet to Strattice may also help. 

Lisa Lynn Sowder, M.D.

How to fix rippling

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Although there is no guarantee, the chances of having visible rippling of breast implants can be reduced by:

  • Using silicone gel implants instead of saline implants
  • Adding soft breast tissue coverage over the implant with fat transfer 
  • Adding soft tissue coverage by lining the implant pocket with a biocompatible material such as Strattice

 

Breast Implant Rippling

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It is unclear to me whether you have saline implants or silicone gel implants.  If the tissue is thin enough, you can see rippling with even gel implants, but always less than with saline.  Textured surface implants ripple more than smooth implants.  If you have anything other than smooth silicone gel implants, you could consider replacing them with smooth gel implants which at least would show less rippling than other implants.  It is also unclear to me whether you were under the muscle to begin with or not.  It appears that your breasts are relatively low on your chest, and it is possible that the pectoralis does not extend down far enough to cover much of even the upper portion of your implants. The pectoralis may cover anywhere from 25%-75%, give or take, of the implant, depending on a patient's anatomy.  When a dual plane technique is used, the muscle is released and may "window shade" higher than normal, and of course the muscle may be over-released, and contract upwards and cover even less of the implant.  Options to provide better implant coverage, assuming the "less rippling" gel implant is what you already have, include fat grafting to try to thicken the tissues over the implant, or using Strattice acellular dermal matrix for additional coverage, although the material is rather expensive.

Fat grafting is a great way to increase the soft tissue coverage of the breast implant and hid rippling

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When there is not enough soft tissue coverage of the breast implants you will see and or feel ripple. All implants ripple but saline implants ripple much more. If you have saline implants you could have them replace with gel. If you have gel and there still is rippling, fat grafting of the breast make a much nicer breast and will hid the ripples if enough thickness is added. 

 

Breast implant ripple toward the inside of the breast

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Though your surgeon may have intended to place your implants into a submusular position during your revision, the ripple on the inside of the breast usually indicates that the implant is still located under the gland only and is able to show through the thinner cover. If the implants stay soft and the shape is attractive it is best to let things be.

Best of luck,

peterejohnsonmd

Fat grafting will help

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The problem is that the soft tissue is thin and does not provide enough coverage for the implant. I would recommend fat grafting to increase soft tissue layers .  This can be done under local anesthesia and without touching the implants. You can check my web site for examples.

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.