Silicone Under Muscle Implants Rippling 5 Weeks Post-op

Thank you for your question. Rippling can be seen when the surface of an implant shadows through the tissue, often found where the breast tissue coverage is thin. Some implant styles are more prone such as an overfilled saline implant. Others are less prone such as a shaped silicone implant. So one approach is to change an implant to one that is less prone to rippling. Another approach would be to add some thickness to the breast tissue. This can be done by fat grafting where fat is carefully layered between the skin and the implant. Another is to add a dermal matrix sheet between the breast and the implant where the rippling is visible to blunt the impression of the implant on the overlying skin. If you notice the rippling soon after surgery, I often recommend waiting until around the six month mark as your breasts may continue to change during that recovery period. I would continue your routine follow up visits with your plastic surgeon who can help monitor for persistent rippling and develop options for you should they persist.

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

#BreastAugmentation : Rippling in thin patientsThin patients like yourself are at higher risk. Its not possible to say if it will get worse. Fat grafting can help some patients#Breastimplants: rippling problemsRippling can be reduced with higher fill implants, #Inspira or saline overfilladding fat , #hybridbreastaugmentation,tightening skin.

Breast
augmentation has extremely high satisfaction rates, but occasionally rippling
can occur following this procedure.This
can occur with either saline or silicone breast implants.Several factors have been associated
with rippling following breast augmentation.These include saline implants, large implants, thin soft tissue, and
placement of implants on top of the muscle.The soft tissue characteristics of
the patient are extremely important.Patients with minimal breast tissue and thin subcutaneous tissue are
much more likely to develop rippling than those with thicker soft tissue.A large amount of breast tissue relative to
the implant size minimizes the potential for rippling.Larger implants, saline implants, and
placement on top of the muscle are all associated with a higher incidence of
rippling.The potential for rippling can be
decreased in several ways.It’s
important in high risk patients to avoid using implants that are large relative
to the patient’s native breast tissue.Firmer implants, such as silicone and cohesive gel implants, can also
decrease the potential for this problem.Submuscular placement decreases rippling by increasing soft tissue coverage
over the implants.Surgeons should avoid
over-dissection of the pocket and avoid implants that are wider than the
patient’s breast tissue.Finally,
overfilling the implant when using saline can be helpful to minimize rippling,
as well.Despite all these maneuvers,
rippling occasionally may still occur.This is especially true when patients have minimal amounts of breast
tissue.It’s important to realize that
in the vast majority of patients, rippling isn’t a problem.Even when it does occur, most patients are
still very happy.If you’re concerned
about rippling after three to four months, it would be reasonable to discuss
the issue again with your plastic surgeon.

Because you are thin and had naturally small breasts, it will be nearly impossible to completely cover the implant.  It is difficult to tell what is going on and it may be folding rather than rippling. It may resolve or it may require additional surgery depending on several factors. .

Hi there-

Regarding your question, "I am 5 weeks post-op and already have rippling to my right breast. I can also feel the implant. My left one seems fine. I started as an A cup and am 5'6" 117lbs. Is this normal this soon after surgery, and will it get worse?"-

Here's what you need to know...

The ability to see or feel ANY implant through your skin will be greater with saline implants, with any implant placed over the muscle, and in very thin patients who do not have much tissue coverage over the implant.

In your case, it sounds like you have already made the decisions that would minimize the problem as much as possible (having them placed under the muscle and using a silicone implant), and have still experienced the problem- most likely because you are thin and your tissues are thin.

If this is a great problem for you, there are options for improvement that would require another surgical procedure. Discuss these with your surgeon.

Without seeing pictures and/or examining you, it is impossible to give you specific advice.  However, you are still in the healing phase, so don't get too worried.  However, factors like thin skin, small breast volume, size mismatch of implants, etc can all affect results.

 

Good Luck.

Is the rippling something you see, or just something you feel?  Is it only in the lower, outer portion of the breast?  Do you have textured or smooth implants?

Ripples can happen, even with perfectly done surgery.  They are more common in saline implants (about 10 %) compared to silicone gels ( about 1%).  Usually they are more common in women who are very lean / low body fat, who don't have much "padding" over the implant.

There are a couple of treatment options.  (See your local board-certified plastic surgeon for a consultation.)

All the best,

The discussion shows you that all implants ripple and the amount you are cognizant of depends on the amount of breast tissue you have to cover the implant. It is true that silicone ripples less than saline and is less palpable.  The new 410 implant is probably an excellent choice but is not widely available because it has not yet received complete FDA clearance. The down side of the 410 is it is much firmer than the regular implants.

As you can see by the answers, yes this is normal in the sense that it is not ab-normal, but it is not something that someone wants to happen after surgery.  Silicone has less liklihood for this to happen, but both saline and silicone implants can ripple. Will it get worse?  It may, since the implants continue to settle for up to 6 months to a year after surgery.  It sounds like you have less soft tissue coverage over that implant.  Good luck!