What implants are best to prevent rippling? (Photos)

Question

I currently have 550cc mentor saline implants with horrible rippling and thin skin. I have had 3 children and breast fed all of them since I got implants. I want to go up to at least 700cc and go to silicone. I am considering getting the Inspira implants since I want to go gummy and it says they are filled more than traditional silicone implants. Is this the best option to prevent rippling?

Donald R. Revis Jr, MD · Answer

Good morning!I would recommend the MemoryGel HP Xtra- the internal shell fill percentage is the highest, which reduces the rippling the best!

Sepehr Egrari, MD, FACS · Answer

The issue that you present with is unfortunately far too common. Large implants from an under filled profiled implant, and extremely thin tissues. These three are generally a recipe for rippling and scalloping that you have demonstrated in the pictures. The implants have lost their lower pole integrity and given that there is no muscular coverage at the bottom and side, you are seeing such deformity. This is not an easy situation and solution is also not so simple. And, in my experience a simple change to a smaller implant is simply not going to give you long lasting results. My suggestions are to explant. Re-implant with a smaller lower profiled-higher filled implant (inspira) and dermal matrix reconstruction of the lateral and lower pocket, and an inferior mastopexy (lift) to reduce the excess of inferior skin. This is a large scale operation and is perhaps not what you wanted to hear. But, in two decades, I have yet to see a good result with any other option. Going to 700cc is a guarantee for even more dramatic  rippling.Best wishes and make sure you seek the advice of a qualified board certified plastic surgeon who has experience with such revisions.

Richard Baxter, MD · Answer

You are correct that Inspire silicone implants have a higher fill ratio so that helps with rippling. There are now 3 options for gel firmness: Cohesive (same as what is used in gummy bear implants), Soft Touch (a little less firm) and the traditional gel. Soft Touch is often the best trade-off between too firm and unnatural with the cohesive, and too soft. Do not go with larger implants, they will put more stress on the already thin tissue envelope. You may also need an internal bra with Strattice or GalaFLEX mesh.

George Marosan, MD · Answer

Thank you for your question and photos. Silicone gel implants will ripple less. Going to 700+ cc with your thin tissues is a major mistake. You will have the same issues in less than a year. I would even consider ADM (acellular tissue matrix) with submuscular placement of current size implants. I prefer Strattice due to its thickness to cover the implants on the latera/inferior aspects of the breasts to prevent rippling.See a board certified plastic surgeon experienced with complex breast implant surgeries. This is not a simple implant exchange in the hope that a larger implant will fix the rippling. Good luck.

Urmen Desai, MD, MPH, FACS · Answer

I recommend highly cohesive (level 3), smooth, round silicone by Allergan. The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Farbod Esmailian, MD · Answer

Saline implants are highest on the list for rippling and given the combination of saline and your very thing skin, you can see the issues.  Although you have done very well with the way things look and your shape.Silicone would be your best option, but not all silicone are made a like.  You mentioned Inspira and you are on the right path.  Looking at the Inspira line there are 3 options for silicone gel implants.Gummy
Bear term can be somewhat confusing as some patients/doctors refer to it
differently.  All silicone implants are in the form of a gummy bear. 
Meaning, if the implant shell breaks the silicone is cohesive enough that it
will stay together. 
The
original term "gummy bear" was used to describe the highly cohesive,
shaped, textured silicone implant developed by Allergan (Natrelle).  They now have 3 different cohesive
levels of silicone in their round implants.  I commonly describe them as
gummy, gummier, gummiest.  These are technically referred to as the Responsive (Tier 1), Soft Touch (Tier 2) and Cohesive (Tier
3).  
The
Tier 3 is a very firm implant and really does not change its shape when
standing or sitting down.  They tend to stay round all the time.  The
advantage of this implant is that it really minimized the rippling in a patient
with very thin tissue coverage.  This implant, at least in my practice, is
reserved for revision cases in which the patient has very thin coverage.  This would likely be the implant of choice for you given how thin you are.
The
Tier 1 and Tier 2, Responsive and Soft touch are really the go to implants in
my practice for primary breast augmentations.  Some patients are better candidates for one over the other,
based on what they are trying to achieve and their soft tissues.Make certain you see a board certified plastic surgeon to discuss further your options.Hope that helps.

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after breast surgery. Although I cannot provide you with specific advice, some general thoughts may be helpful to you.  
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. Also, breast implant displacement problems (such as bottoming out or lateral displacement), may play a role when it comes to increase breast implant rippling.
 
Correction of the rippling may involve further surgery including implant pocket exchange if possible (sub glandular to submuscular), implant exchange if possible (saline to highly cohesive silicone gel), capsulorraphy (adjustment of the surrounding breast implant capsules to prevent displacement) and/or the use of allograft (acellular dermal matrix) to provide an additional layer of tissue between the implant and the patient's skin.  
In-person consultation with a few board-certified plastic surgeons who can demonstrate significant experience helping patients with this type of revisionary breast surgery will be your next best step. Best wishes.

Lisa Lynn Sowder, MD (retired) - Account Suspended · Answer

First of all, do not go with larger implants.  They will only thin your tissue more!  You would likely do well with Inspira or Inspira Soft Touch.  These have a high fill ratio and are still reasonably soft.  I think a highly cohesive implant wont feel very natural in someone as thin as you.  Also, some additional padding and support with something like Strattice may be beneficial although it will be very, very expensive.

Ronald V. DeMars, MD (Retired) · Answer

Although not all patients with saline implants have issues with rippling, that is the most common complaint with those implants. Patients with your physique sometimes have rippling with silicone also, although it is never as obnoxious as the saline ones. The more cohesive the implant, the less rippling patients notice, but the trade off is the implants are more firm and loose some of their natural feel.

Richard P. Rand, MD, FACS (retired) · Answer

There are a few issues to consider for improving your result:1. Changing to gel will be much better. It isn't so critical using the overfilled ones.2. Be sure you are under the muscle. This won't prevent lateral rippling but it is at least covering the implant with as much tissue as possible.3. Going way bigger will thin your tissue out even more, making the rippling even more problematic. Maybe reconsider this.4. Your implants are too far lateral giving an unacceptable gap in the middle. Maybe just centralizing them will prevent the need to go substantially bigger.

What implants are best to prevent rippling? (Photos)

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