I am a little over 4 weeks post op allergan 492cc round mod plus subpectoral augment. I am 33, 5'3" 110lb, with already wide set breasts, previously a 32C with some breast tissue with loose skin. Visible rippling/implant edge laterally, now seeing rippling medially one breast. Options? Thank you!
What to Do About Rippling with Silicon Implants?
Doctor Answers 11
How to correct rippling of silicone gel implants under the muscle
Thank you for your question. I am sorry that you are seeing rippling of the silicon gel implant after sub-muscular breast augmentation. The only solution I can think would be to have a revision during which acellular dermal substrate such as Flex HD, Strattice or AlloDerm is placed over the implant.You will likely need to wait 3 or 4 months for this revision.
Rippling and silicone breast implants
It is too early at 4 weeks to conclude anything but in general if silicone gel breast implants are rippling it's because of a size discrepancy between the implant and the capsule around it or because the capsule is not smooth and even around the implant.
The way to understand rippling is that the term is confused between look and feel. All saline-filled implants feel ripply because that's what saline feels like if you can feel it. If the tissue coverage is adequate then it is still ripply but you don't feel it. If the implant isn't filled properly, has a size to capsule problem, or has attachments of the implant to the capsule from surface texturing then the rippling will be worse and can even be visible upright.
Gel-filled breast implants do not inherently feel ripply. They feel like tissue and this is why they are used because the tissue coverage doesn't matter. In general they don't ripple or feel ripply regardless of the coverage but they can seem to feel ripply if the implant can't position properly in the capsule around it or the capsule is not smooth and/or the implant is attached to the capsule (which yours can't be if they're smooth surface and round Allergan Style 15).
If the rippling feel persists after full resolution of the tissues, then a revision would be required to make sure the capsule has adequate size for the implant and the capsule is smooth and even. Tissue coverage can be bulked up with a dermal graft like Alloderm but this is expensive and not as important as the characteristics of the capsule at least for gel implants. Another option might be to wait for the 4th generation (gummy bear) gel implants which might help with this problem. Currently the US government will not allow you to choose them although there is extensive experience with them in Canada and elsewhere in the world.
The use of grafts of an acellular dermal matrix or you own fat are viable solutions.
When patients have visible rippling following breast augmentation there are several solutions to help correct this problem. These would include repositioning the implant beneath the pectoral muscle if they had originally been placed above the muscle. If the implants were saline filled then changing the implants to silicon gel would help since the latter are associated with less visible rippling. However, since these maneuvers were incorporated in your original operation the options become more limited. The use of grafts of a acellular dermal matrix or of your own fat over the implants in the areas of visible rippling remain two viable alternatives. You should consult with your Surgeon about these alternatives.
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Options for rippling with silicone implants.
The problem you are experiencing are likely due to your thin breast tissue. Options for managment include switching to high profile implants, acellular dermal matrix coverage, fat grafting.
Rippling under the muscle with silicone
It sounds like you are very thin. The best way to camouflage the implants is to use a thick piece of alloderm to provide an additional layer of soft tissue coverage.
Ripple can be seen with a silicone gel implant and thin cover
The appearance of a silicone gel implant can depend on the breast tissue available to hide the implant from view. Submuscular placement is usually the best option, especially in a thin breast. Many are surprised to hear that a silicone implant can indeed ripple or show a fold as can a saline implant. With your current full 492 cc implant, you might consider a smaller size, and you may have a better result. Another consideration is a form stable implant such as the Allergan 410 implant which has a lessor tendency to ripple.
Best of luck,
Factors that are associated with increased rippling include:
- Traditional Saline implants (IDEAL® Saline implants less likely)
- Textured implants
- Large implants
- Thin patients with low BMI
- Implants placed above the muscle
- Prior history of rippling
- Heavier and larger breasted women
- Using a highly cohesive form-stabile silicone implants (gummy bear)
- Smooth implants
- Smaller implants
- Submuscular placement
Wait for your results to appear first
Implant rippling options
Placing the implant under the muscle and using a gel or silicone implant is the best way to minimize rippling. If the ripples are persistent then you may consider using alloderm (acellular dermis) to line the implant pocket and provide more coverage of the implant.
Options to conceal rippling with silicone implants
As you have experienced, all implants tend to ripple, some more than others. Yours are style 15 which I think ripple less than other gel implants. So concealment by adding "padding" is what is needed, and you have already made a good choice by going under the muscle. However, there is no muscle coverage laterally or on the bottom, so that is where it is most typically seen. Medially it may be due to partial release of the muscle in order to try to get the implants close together. Options to improve coverage include fat grafting and the use of grafts to the scar capsule. The best material for this is called Strattice. Info here: www.renewingyou.com