20 year old breast implants are rippling - what is the best option for revision?

Question

I am a mom of 4, breastfed them all, very athletic , 48 kg x 160cm. My implants were done about 20 years ago and are over the muscle. I have 260cc. I have only in most rescent years noticed a lot of wripling appearing especially on the top part. I have non existant breast tissues and skin is super thin. I have seen a surgeon who is advicing to keep the muscle intact given I am super sportif, and this surgeon would use MOTIVA ERGONOMIX 315 or 330cc, FULL, over the muscle to preserve all its functionality. I have seen a more Sr. Dr. who is advicing to go under the muscle (he does not perform dual plane but he places the implant under the muscle in an 'appropriate' way to minimize animation deformity to the maximum. He advised not to go over the muscle given my super thin tissues. Fat grafting is not an option as it is non existant in me. I will also at the same time be performed from both opinions a periareolar mastopexi. I do not know the implant brands of the more Sr. Dr. as he didnt share and I didnt ask. I know the first surgeon would use MOTIVA ERGONOMIX and he thinks those specific implants minimise the risk of wrippling. I am confused and do not know that to do and who to follow. In a wayI probably do need extra coverage in the upper pole of the breast given by the muscle. But shouldnt it also be given by the MOTIVA ERGONOMIX including the mastopexi ? I am worried about animation deformity and also not gaining back all my pec strength for my high level intensity sport

Harry T. Haramis, MD, FACS · Answer

Without photos, difficult to answer about lift.

Generally, if it is only rippling and you want more upper fullness, then exchanging for proper implants should be enough.

If you want to stay same plane, above muscle then a higher fill density implant such as Motiva progressive or Natrelle soft touch should limit wrinkling. Also go slightly larger cc’s.

Another option may be biological mesh to cover the implants since you have thin tissues.

Further discussion with your/a plastic surgeon is recommended for your best option.

Ronald J. Edelson, MD · Answer

I would place the new implants under the muscle. Forget fat grafting. It won’t work. The implant type and size you mention is a good fit

Gregory A. Buford, MD, FACS · Answer

Without photos, it is hard to really give you advice here, but if you have thin overlying tissue and are already seeing rippling then I would agree with going under the muscle. The subfascial approach is being touted as the newest thing but in reality there is no perfect approach. If you have rippling then putting them above the muscle is potentially going to increase the rippling although the newer Motiva implants are more cohesive and so may reduce some of this effect.

I would recommend going under the muscle with the Motiva implants.

Hope that helps and I wish you the very best in your surgical journey!

I would recommend going under the muscle with the Motiva implants.

Hope that helps and I wish you the very best in your surgical journey!

Thomas A. Mustoe, MD, FACS · Answer

I have done a few thousand impact surgeries and in my strong opinion, although Motiva implants may reduce rippling it will still be an issue in a thin patient over time. A careful partial dual plane dissection will not weaken the muscle and I have never had complaints about animation deformity even in body builders and thin patients competing in competitions.  There is some increased motion of the implant but it is not visible in clothing and patients do not fond it disturbing. Although Motova implants are excellent implants so are others from the two leading implant manufacturers.

20 year old breast implants are rippling - what is the best option for revision?

Answers (4)

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