Switching from saline to silicone..what shape?
Dear M.R. - The moderate profile plus is a medium profile that, in my opinion looks more natural than the high profile. Remember that saline implants are overfilled and look more projected anyway. My biggest concern with your case is that your main issue is rippling and your PS is placing the implants back in the same pocket. I would most likely put them under the muscle, especially at your height and weight. Obviously this is a guesstimate made without seeing you in person.
Switching from saline to silicone gel implants can decrease rippling, but each person needs to be treated individually. Rippling can happen in front of and behind the muscle, but it is more likely in front of the muscle. Sometimes changing the implant position is more important than the type of implant.
If your rippling is due to capsular contracture, releasing the contracture may help. If your rippling is because you are very thin, and there is not enough soft tissue to disguise the contours of the implant, then moving to behind the muscle makes more sense.
When the implant is behind the muscle, the outer edge is not completely covered, so rippling can occur in this area. When the implant is in front of the muscle, rippling is more easily seen over the entire breast.
Unfortunately, I cannot give you any specific advice via this forum; however, if you are uncertain how to proceed, it is worthwhile discussing your options again with your plastic surgeon, and you might consider getting a second opinion via an in person consultation. Thanks for your question.
Breast implant swap for 'rippling'
The treatment plan you describe does not make a lot of sense- if you've got implant wrinkling, that implies that you need more soft tissue coverage over your implants. Replacing with silicone implants in the sub-glandular position is not going to provide that. Sometimes a procedure that is 'less intrusive' does not deliver the result that you're going to be happy with.
Switiching implants from above saline to silicone and high to moderate profile
It is difficult to say if this will completely eliminate the rippling but it will certainly reduce it. It is thought that high profile silicone implants have less rippling than moderate. However, your moderate profile will have a softer contour and project less.
Rippling happens when the soft tissue covering is very thin. Sometimes there is less rippling with silicone. If there is still rippling after silicone exchange, you may want to consider alloderm placement to add another layer of coverage internally.
Implant exchanges due to rippling
Thank you for your question. Implant rippling is due to two issues - the viscosity of the implant (ie saline vs. silicone) and the thickness of the overlying soft tissue to camouflage the implant. You state that originally you were an A cup. For most women with very small breasts to begin with, a submuscular placement of a breast implant is advised to hide the implant. For patients having problems with rippling of the implants in the upper poles of the breast, I recommend a pocket change to submuscular. Silicone implants are less likely to show rippling, however, if the tissue is thin, they will ripple. For women with severe rippling in the lower pole (which can happen with submuscular implants as well as subglandular), the addition of a dermal matrix such as Strattice can help significantly.
As for changing shape of the implant, a moderate plus device is flatter, but care must be taken to properly set the pocket to the implant width to avoid long term distortion of the implant in a reaugmentation case. Some women do feel the moderate plus look is more "natural" than the high profile look.
Position change for ripling can help
I agree with Dr. Sattler on this one. Switching to silicone can help with ripling, but most plastic surgeons would agree that the sub-muscular position will also decrease visibility of the implant. If you are going to go through a surgery to correct the ripling, I would suggest changing the position at the same time; that way you only have to go through one operation.