Silicone Under Muscle Implants Rippling 5 Weeks Post-op

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? Thanks

Doctor Answers 24

Rippling of breast implants

Thank you for the 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.

Having discussed these issues,  PREVENTION of rippling/probability is of critical importance.

Much of the final “look” achieved after breast augmentation surgery  depends on several factors:



1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” and "feel" will be optimal.




2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.  Make sure you're working with a well experienced board-certified plastic surgeon.



3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.




4. The size and model of breast implant used may  make a  significant difference in the final outcome,  including the presence of rippling/palpability  of the implants.

 I hope this helps.

 

Rippling Felt Soon After Surgery

It may be normal to feel rippling on one breast, and not the other, even as early as 5 weeks post-op.

There are a few factors that contribute to being able to feel or see ripples after having breast implants.  Most important is the amount of natural breast tissue you have to cover the implant and the size of the implant compared with your natural breast size.

There are techniques that can be discussed with your surgeon for potential improvements:

  1. gel vs. saline implants
  2. submuscular vs. subglandular position
  3. smooth vs. textured implant surface
  4. smaller implant size
  5. fat grafting
  6. allograft (tissue implantation)
  7. implant removal

or, just accept the inherent imperfections of a cosmetic procedure, if they don't bother you too much.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.6 out of 5 stars 31 reviews

Rippling with breast implants

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.

The relative "thickness" of the breast skin brassiere is an important determinant of breast beauty

Nursekb: given your pre-op slim frame and small cup size, palpable rippling would be expected, especially in the inferior (lower) pole of the breast. The upper pole palpable rippling is camouflaged by the pectoralis major muscle, which covers 50-60% of the implant.  Palpability of the implant may be exacerbated by the choice of a textured implant, which is intrinsically more rigid and prone to the development of folds and knuckles, which are best appreciated when you bending at the waist. 

The current "solutions" for thin women with thin skin aren't very satisfactory.  Some surgeons advocate structural fat grafting to "thicken" the skin brassiere.  This technique is very operator dependent and may result in microcalcifications, which can be confounding in subsequent mammograms.  Others may suggest using acellular cadaveric dermal matrices, (Alloderm, Strattice, MTF, Allomax, etc.), which are uber expensive.  In applying these as inferolateral "hammocks" they may theoretically mask the thinness of your breast skin.  Finally, the "solution" of gaining weight, to increase the fatty component in your breasts, is both impractical and unpredictable.  Do discuss your concerns with your surgeon and elicit their approach.  Good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 56 reviews

Rippling Concerns: Speak w/ Your PS

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.

Palpabiliity of implant over lower portions of breast

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. .

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 72 reviews

Rippling after silicone breast augmentation

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.

Breast Implants

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.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 72 reviews

WHY are my Under Muscle Breast Implants Rippling 5 Weeks Post-op?

Regarding: "Silicone Under Muscle Implants Rippling 5 Weeks Post-op
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? Thanks
"

I am sorry for your predicament but it sounds like you were not educated properly by your Plastic surgeon on what to expect.

ALL breast implants ripple to some extent. Saline filled implants ripple much more than silicone filled implants (which is why I suspect your surgeon recommended these implants). Because of the inevitable rippling we try and cover the implants with as much soft tissue as possible including placing them under the Pectoralis Major muscle. However, even in the under the muscle position, the side and bottom of the implant are close to the skin and can ONLY be covered by the available breast tissue. If the diameter of the breast implant used exceeds the amount of available breast tissue "roof" the implant will be under the skin where it and its ripples will be felt and possibly seen.

As the swelling in the tissues goes away the skin will move closer to the implants and their ripples and more will be visible and palpable. Moreover, with time as some of the breast tissue goes away and atrophies (due to pressure from the underlying implant) and aging, even more of the implant and its ripples will become unroofed.

Picking a silicone gel implant was the right decision. We cannot comment as to the volume implant chosen. Your options for the future may include placing fat grafts in the skin over the implant or a biological hammock such as Alloderm or Strattice.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 102 reviews

Rippling implants

You sound thin and having little breast tissue, you are a set-up for rippling.  It may get a little worse as all the swelling goes away or if you lose any body fat.  But at least with silicone you are doing all you can to minimize it.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.