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 implants
- Large implants
- Thin patients with low BMI
- Implants placed above the muscle
- Prior history of rippling
Factors which are less likely to have rippling include:
- Heavier and larger breasted women
- Using a highly cohesive form-stabile silicone implants (gummy bear)
- Smooth implants
- Smaller implants
- Submuscular placement
Once 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.
In my experience, all breast implants can have some degree of rippling in the position that you show. Saline implants can ripple more than silicone gel implants. Sometimes fat grafting over the area of rippling or the placement of a piece of Strattice to act as a barrier between the implant and skin can ameliorate the situation. If you're going to go smaller, you might want to consider using an Allergan 410 shaped implant as it has the propensity to wrinkle less than any other implant. Some adjustment of your pocket will likewise be necessary. Unless you're going considerably smaller, it shouldn't need skin lifted. Good luck.
Revision with Lift for Rippling
Hello and thank you for your question. For women with moderate to severe breast sag, a breast lift (mastopexy) may be recommended along with augmentation to ensure the best result and longest lasting result. Failing to have a breast lift when necessary will only lead to a less than ideal result leaving the patient unhappy and needing a revision surgery, so it is possible that you should have had a lift in your initial procedure. A larger breast implant can help lift the breast, but the low hanging breast tissue will still be present causing a disconnect between the implant and breast tissue located at the bottom of the breast. I think it would be your decision as to whether a revision were needed if you are unhappy with the rippling and any sagging.
Do I need a revision for the rippling breast?
I am sorry to hear about your concerns after breast augmentation surgery. Yes, you should be able to undergo downsizing of breast implants. Keep in mind as you are thinking about your goals that sometimes adjustment of the breast implant pockets (capsule adjustments) may be necessary to achieve the outcome you are looking for. Breast lifting would likely not be necessary unless you wish to downsize breast implants very significantly. The use of acellular dermal matrix may be very helpful when it comes to improvement of breast implant rippling or palpability.
Generally speaking, the best online advice I can give to ladies who are considering revisionary (downsizing) breast augmentation surgery is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "down a cup size” or "C or D cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.
3. Once you feel you have communicated your goals clearly, allow your chosen plastic surgeon to work with you in determining the best plan to achieve your goals.
I hope this, and the attached link (dedicated to revisionary breast surgery, specifically downsizing breast augmentation surgery concerns), helps. Best wishes.