What are the best implants for someone who is thin and consequently has very little breast tissue?

Question

I currently have Natrelle Inspira (SRM) implants along with some fat grafting. I am thin and consequently have very little breast tissue. As a result, I have a lot of visible rippling. I would like to switch out my implants to ones that are less likely to show rippling. There are SO many styles - it's a little overwhelming. In a case like mine, what style of implant should give the best result? Thanks :)

Gerald Minniti, MD, FACS · Answer

Hello,The recipe for minimizing rippling includes the sub pectoral placement of small, low profile implants, which are highly cohesive. Best of luck!

Richard Baxter, MD · Answer

Inspira implant were an improvement over previous Natrelle implants because of the higher fill ratio, but they can still show some rippling in thin patients. The newer versions (soft touch and cohesive) have firmer gels so they will ripple less, but be careful about going to a higher profile.

Dallas Buchanan, MD · Answer

Thank you for your great question. As the coverage of the implant gets thinner, the more the implant is visible. For very thin patients who are trying to avoid rippling, placing the implant under the muscle is the most important thing to do. After that, implant selection can help. The more cohesive the gel, the less rippling you will have but the more firm the implant will be. If you have SRM implants now, ask your plastic surgeon to show you the SCM implant from Allergan. This implant will have the same volume and measurements as your current implant but the gel will be more cohesive. If you do not like the current shape you have, you could consider switching to a cohesive shaped implant as well. Discuss all these options with your plastic surgeon.Hope this helps!

Alexander G. Nein, MD, MS, FACS · Answer

Very thin women with very little breast tissue are more likely to show visible rippling regardless of type of implant. There are a number of options which can reduce that risk and fortunately in most cases camouflage 'visible' rippling. (With very thin women there may always be rippling that you can feel, especially at the lower outer portion of the breast.)First stay away from saline implants. They are notorious for rippling which is why in the majority of cases they are placed under the pectoralis muscle. Placing the implant under the muscle gives some more padding over the implant to camouflage rippling and also the natural muscle tone puts a little pressure on the implant to help 'fill' out the ripples. Placing the implant under the muscle is also an option when using silicone implants especially in small breasted women for the same reasons.Implants also come in different fill volumes and different amount of cohesiveness. The Allergan SRM implants that you have are the softest that Allergan makes. There are two other options the SSM and SCM which are progressively firmer and thus less likely to ripple. The trade off is that these implants are firmer and thus less natural in softness. Implant size is also a factor. The larger the implant the more likely that ripples will be visible. Larger implants have bigger ripples than smaller ones and are thus more likely to be visible. Also a smaller implant with less projection will ripple less.Another option to increase the coverage over the implants is to add a layer of ADM (acellular dermal matrix) to the inside of the breast pocket in the areas where the rippling is most prominent. This is somewhat more expensive and carries a few additional risks and potential for complications.Finally, fat grafting which you've already had done is another (albeit more complex) way to add soft tissue coverage over the implant.Talk to your plastic surgeon (and possibly others as well)  in detail about your options. That way you can get an idea of what the best options are for particular situation.Best wishes!DrNein.com

Tom J. Pousti, MD · Answer

Thank you for your question.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.
Correction of the rippling may involve further surgery including implant pocket exchange if possible ( sub glandular to submuscular), implant exchange if possible (saline to silicone), and/or the use of allograft to provide an additional layer of tissue between the implant and the patient's skin. Patient weight gain (if possible) may also be helpful.I hope this helps.

Michael C. Edwards, MD, FACS · Answer

The less cohesive an implant is, the more any ripples and wrinkles will show through thin tissue. The Inspira line of implants by Allergan offers 3 levels of cohesivity. Trueform One/Inspira is a great implant for the patient with good coverage. Trueform Two or Soft Touch, is a newly released implant which I use commonly and is a little more cohesive. Trueform Three/Highly Cohesive implants (have also been called Gummy Bear) are wonderful for really compromised coverage in very thin patients or breast cancer reconstruction patients. You should meet with an experience board-certified plastic surgeon for your revision surgery.I hope this helpsDr. Edwards

Marc J. Salzman, MD, FACS (retired) · Answer

Thank you for your question. It does sound daunting in this day and age of so many choices. Generally speaking, as the level of cohesiveity in the gel goes up, and the relative fill volume to the potential fill space goes up, there is less potential for wrinkling. The Natrelle Inspira Cohesive implant fits the bill in all of those categories for me. The downside is that it does feel a little stiffer than the more fluid gel in the regular Inspira line. Hope that's helpful.

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