Sculptra for Breast Implant Rippling

I have used Scultpra specifically for the problem you are describing - visible breast implant edges in a thin woman after implant reconstruction. In fact, I have published this specific technique in the Breast Journal in 2009.  You can view this entire article on my website - drschulmanplasticsurgery.com/Breast-JournalCorrection-of-Chest-Wall-Deformity-After-Implant-Based-Breast-Reconstruction-Using-poly-l-Lactic-Acid-Sculptra.pdf

The other options listed such as fat injections and Alloderm/Strattice are other options. The advantage of Sculptra is that it only involves office injections (you may need 4-6 treatment sessions) and does not require a surgical procedure like the other techniques.  I agree that you should only choose a doctor experienced in Sculptra and specifically this technique so it may involve you traveling for this (to NY perhaps).

Sculptra can be used off the face and is gaining popularity as an alternative to surgery for:1.  Sculptra Butt Lifts2.  Filling in rippling effects around breast implants3.  Correcting liposuction deformities on the arms, legs, abdomen.4.  Treating sun damaged skin in the décolleté area5.  Filling in the thighs to enhance buttock curves6.  Augmenting bicep and trips in the arms7.  Treating cellulite8.  Filling in bra line indentations9.  Treating crepe arm skin10. Male pectoral and calf enhancementAnd much more 

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 implantsLarge implantsThin patients with low BMIImplants placed above the musclePrior history of ripplingFactors which are less likely to have rippling include:Heavier and larger breasted womenUsing a highly cohesive form-stabile silicone implants (gummy bear)Smooth implantsSmaller implantsSubmuscular placementOnce 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.#rippling#breastaugmentation

Thanks for your question -

In our San Francisco area practice we would not typically use Sculptura or other injectables in this "off label" manner.  There are several issues:


Typically rippling is a consequence of thin tissue over the implant - this can cause damage to the implants when injections are applied.

Multiple injections in the area increase the risk of implant infection.

The volume of the injections that must be used can be very expensive.


Instead consider using acellular dermal matrix to provide an additional layer of tissue between your skin and the implant.  This techique has multiple advantages but does require a trip back to the operating room.

You should also consider silicone implants which tend to ripple much less than saline.

I hope this helps!

I would avoid Sculptra for the breast region as the skin is thin and nodules may develop and then show. I also wonder if there would be any concern with Radiologist's interpretation of mammograms in the futurre.

I would suggest rejecting the suggestion to use Sculptra or Artefill as a means for implant concealment. The most efficient way to conceal visible wrinkling is to place the implant in the submuscular position. Addition of Strattice acellular dermal matrix might also be helpful. Fat grafting can also be useful.

1.  Make sure you're seeing a surgeon who is specifically certified by the American Board of Plastic Surgery (NOT "cosmetic" surgery).  And find out whether the surgeon does a lot of breast revision work.

2.  Sculptra is NOT the answer here.  Completely off-label, unpredictable in the breast (I would imagine), and cost-prohibitive for the amount you likely need.  Plus, it's not permanent.  Same goes for Artefill, except that it is considered permanent (lasting longer than 5 years).

3.  Consider moving the implants to the subpectoral position. Even in thin women, the muscle at least provides additional implant coverage.

4.  Talk to your plastic surgeon (not 'cosmetic' surgeon) about using Strattice or Surgimend or Alloderm--some form of acellular dermal matrix, to thicken the tissue coverage. 

5.  Talk to your surgeon about fat transfer. Fat grafting is a great adjunct to many breast surgeries.

I often have to use more than one of the above options to get a good resolution to the problem of implant rippling in a thin woman.  Good luck!

Regarding: "Sculptra for Breast Implant Rippling
A cosmetic surgeon suggested Sculptra or Artefill for breast implant rippling. I am 4 wks post op with revision surgery. Subglandular saline implants replaced with Silicone high profile implants. There is already noticeable rippling. I am very thin so submuscular placement may not help much. I also have considerable sagging so would need a lift with submuscular placement. I would like to avoid a lift since I have had problems in the past with scarring. Any advice greatly appreciated."

Obviously you are well-read on breast surgery and yet- you twice managed to take the wrong fork in the road further complicating the condition of the the breasts.

If you knew you thin skinned you should have had smaller, silicone gel implant placed submuscularly the first time around (to minimize sagging and rippling). A month ago you lost another opportunity to correct your breasts. You probably should have had a submuscular silicone gel implant, breast lift and a Strattice sling to hold the implant and cover the ripples.

The use of Sculptra in the breast is at best controversial. The use of artefill, a gritty, fine sand like filler in the breast in my opinion borders on the irresponsible or worse when there are so many other options which are less noxious.

As regards "I would like to avoid a lift ", I fully understand your reluctance. It is shared by millions of patients and plastic surgeons alike. But THE ONLY WAY to correct a sagging. droopy breast is with a lift NOT with larger implants, fillers or even acellular dermal matrices used by themselves.

If you want the MOST attractive breasts you can have, you must have everything done properly and instead of having partial procedures or worse yet, experimental, ineffective or injurious procedures.

Your concerns are very complexing and need great personalized attention. Over the internet any recommendation are a guess. Because you failed to post photos and your surgery history is a bit confusing. Seek in person opinions for a treatment plan. Personally I would not use SCULPTRA in this area, I would try Selphyl. 

I am concerned about the term "cosmetic surgeon". I have found over the years that doctors without approved training and test certification of the American Board of Medical Specialties call themselves a nebulous term "cosmetic surgeon". Please make sure you are in the right office before proceding. As a board certified dermatologist, I do a lot of Sculptra, but no breast implants, so that is my only comment.