Options for Rippling and Firmness from Saline Implants?

I have under the muscle saline smooth implants that ripple and are too firm. Before this I had silicone implants above the muscle that ruptured. They were rock hard and made me very ill. I would like to get rid of the rippling and firmness. Vitamin E did not help and I think that a 3rd surgery would do the same. Are there any real solutions to this? What about Dipulse? Thank you.

Doctor Answers 17

Options for Rippling and Firmness from Saline Implants?

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Some of the reasons for visible rippling in an implant:

1. thin skin and minimal breast tissue with visibility of normal folds
2. moderate profile saline implants are more likely to ripple than high profile saline
3. saline are more likely to ripple than silicone implants
4. over the muscle placement are more likely ot have visible rippling than under the muscle
5. weight loss may make rippling more noticeable
6. involutional breast atrophy after nursing may make rippling more apparent
7. breast ptosis (sag) may make rippling more pronounced
8. capsular contracture with "scrunching" of implant causing folds
9. textured surface causing folds and knuckles
10. partial deflation of implant with collapse and folding
11. underfilling of implant
12. flipping of implant

Rippling is inevitable but can be lessened

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Rippling of the implants is much more noticeable with saline than with silicone. This is because the saline implant is basically a bag filled with water and is compressed by external forces of healing. In order to minimize the rippling, plastic surgeons will overfill an implant a certain amount. Silicone implants, because the gel is so thick, don't ripple as much. If the rippling is significant this is a concern to the patient, more tissue will need to be brought in to cover the implant. This means moving the implant under the pectoral muscle if it's not a ready positioned there, moving muscle from the back to cover the implant, or covering the implant with material such as Alloderm or Strattice. Discuss this with your plastic surgeon so that you know your options.

Treating capsular contracture

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Rippling is quite common with saline implants especially near your breast fold or between the breasts. Typically, most surgeons would recommend silicone implants but you have not tolerated those very well. Some surgeons have used an asthma medication in a form that is not FDA approved to treat the condition of capsular contracture, or scar tissue, to soften the breasts. Perhaps visit with your surgeon and see if that is an option.

Options to treat scarring and rippling around breast implants

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It appears as though your options are limited. Treating rippling and scarring (capsular contracture) around breast implants is difficult with non-surgical options. If you do decide to have surgery to treat the problems, talk with your plastic surgeon about placing Alloderm or some other dermal allograft over the implant to help prevent visible rippling. Good luck! (eat some Imo's pizza for me...I'm from St. Louis and I miss it!)

Solutions for rippling, wrinkling and firmness

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I concur with the other opinions that there isn't currently a single "magic bullet" to prevent rippling and wrinkling. Even some of my breast cancer patients who have silicone implants, Alloderm and Strattice slings, will have some wrinkling in certain positions. It certainly is a great opition, however the price of these dermal grafts is a major deterrent.

It's just not practical to advise a woman to gain weight, hoping that additional fat will camouflage the area, which lies below the pectoralis major muscle. However there is a lot of interest in structural fat grafting to camouflage this area. I am waiting for the academic centers to provide more longitudinal data on outcomes (safety, nodularity, confusion with mammography, etc.) before I start to offer this to patients.

As far as the firmness, there could be two explanations: a) capsular contracture = the expected reaction of the body against foreign material, essentially forming a scar layer around the implant; b) implant overfill which is sometimes done to reduce wrinkling around the implant but confers a harder feel to the implant.

Hope you can hang tight, for now. There are options but no firm solutions at present.

Good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Correcting rippling saline implants

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You have a difficult situation certainly. You are probably thin and the minimal tissue over your saline implants doesn't hide the rippling despite an overfill (hardness).

Really, the only real options you have are either to accept the situation and leave it alone, change back to the new silicone gels under the muscle, use Alloderm to line the pocket, or gain a few pounds. Good luck!

Saline implants that ripple and are firm

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Saline implants may ripple. Traditional silicone implants ripple less. The Allergan 410(gummy-bear) implants don't ripple. They are currently an FDA investigational device.

In patients with thicker tissues rippling may not be noticed. If saline implants are "over-filled" they can feel firm and still have palpable or visible "scalloping" due to the over filling.

The only way to absolutely be certain you won't have future implant related issues is to take them out and not have them replaced. If that is not an option you can accept, then there may be some other options, but all will have a chance of some recurrence of problems.

A consultation with a plastic surgeon experienced in revision breast surgery can give you specifics after a full review of your history and an examination. If you have very thin tissues your surgeon may suggest the addition of additional "tissue". One such option is Strattice, it may help to camouflage any rippling.

If the firmness you are experiencing is from capsular contracture, your surgeon may discuss using a textured surface implant placed beneath the muscle.

John E. Gross, MD
Los Angeles Plastic Surgeon

Options for firmness and rippling after saline breast implants

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Sorry to hear about your situation. From what you have described you had a reaction to the ruptured silicone implant done in the past and now you are having problems with sub-muscular saline implants. Most likely your skin is thin and the rippling of the saline implants just "shows through". This firmness is most likely capsular contracture, a thickening of the capsule surrounding the implants.

There is no simple solution to your situation. The new silicone gel implants with cohesive gel are much less likely to leak and would be less likely to have rippling that shows. Covering the implant with Alloderm is another option. Doing a "total sub-muscular" implantation may give you a better result. I would also suggest a smaller implant. There can be no guarantee that the situation can be improved.

Joel B. Singer, MD
New York Plastic Surgeon

Options for rippling and firmness from Saline implants?

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Dear Tabatha9999,

Sorry to hear about your predicament. Unfortunately, there is no ONE way that will predictably solve it.

As regards Diapulse. We have no scientific proof that it will solve the situation not that it will worsen it. You MAY want to try it knowing that we do NOT know either way if it works. http://www.healingtherapies.info/diapulse.htm

"I have under the muscle saline smooth implants that ripple and are too firm" - unfortunately ALL implants ripple to some extent but saline implant ripple more than silicone gel implants. The fact that the ripples are visible means the implants are NOT covered as much as they should by the overlying breast tissue. To correct it, you would need smaller implants which would be covered and maybe adding another layer in between of something like Alloderm or Stratise. So maybe smaller gel implants would be a starting point to consider.

The hardness could EITHER be an overfilling of the saline implants or formation of tight scar, aka capsule around the implants. In other words, a recurrent scar of the condition you had with your first implants. This scar would have to be partially excised and THEN treated with Vitamin E etc hoping it would not recur.

I am truly sorry this happened to you. But review these options and see which ones sound the best to you.

Good Luck.

Peter A Aldea, MD, FACS

Peter A. Aldea, MD
Memphis Plastic Surgeon

Rippling with saline implants

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If you currently have rippling from saline implants, it sounds like you need the scar tissue removed (capsulectomy) and the implants converted to silicone; which have a very low incidence of rippling. You previously developed capsular contracture with your implants that were place in front of the muscle (subglandular) therefore it is possible this can occur again. Vitamin E can help, and also Singulair, which is an anti-inflammatory medication used for asthma but has been shown to help soften/prevent the development of scar tissue.

Unfortunately, another surgery is likely the best way for you to achieve a softer breast.

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.