Implants Placed Submuscular Yet Can See Rippling on the Outer and Bottom Sides, Even in Cleavage, Options?

It does not sound like your implants are submuscular. You are quite thin so the edges of the implant will be visible as rippling if the soft tissue coverage is inadequate as would be the case if the implants were above the muscle or on the outer lower edges where there is never muscle coverage of the implant edges. If there is any doubt about the implant position you need to be examined by another surgeon and possibly get ultrasound verification of the implant position. If they are not under the muscle they will need to be repositioned.

If they are under the muscle you will need to increase the soft tissue thickness over the areas of rippling. The cohesive gels are supposed to have less rippling than other types of breast implants so changing to another type of implant is not a viable option. That leaves you the only option of acellular dermal matrix (see the referenced webpage). Given your weight and height I do not think you will have sufficient fat elsewhere to allow for fat grafting to these areas.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

This is normal as your tissues relax and accommodate the additional volume of the implants. It is more common in patients with thinner skin and less of their own natural breast tissue.

All implants have wrinkling. If you visit your surgeon's office to try on sample implants, whether saline or silicone, they all wrinkle when you hold them in your hand. Wrinkling is less obvious with silicone implants. So you can at least feel good that you chose silicone.  Your tissue is evidently thin enough, even though part of your implants are under your chest muscles, to allow the wrinkling to be visible.  Wrinkling may be part and parcel of having the implant, especially if you are thin. Much of your implant may not be covered by muscle, like on the side and at the bottom  Additional surgery to place a sheet of tissue (biodermis) can be done to improve wrinkling, but this is costly.  Sorry you are having trouble. All the best, "Dr. Joe"

Dear Tarang,

The only thing that will work is to gain a few pounds. I would highly discourage trying to work your pecs as this might actually push the implants out of place and give you more problems. I've seen this many times on patients that are workout instructors. Best of luck, Dr. H

Are you sure your implants were placed in a submuscular position?  I would make sure of that first. Given your weight, you are at risk for rippling.  One other option not mentioned already would be fat grafting to provide more cover over the implants.  Essentially, your fat from another part of your body would be carefully injected in the areas where you have rippling.  This has to be done by someone who is experienced so that the implants aren't damaged.  Good luck. 

Rippling should be significantly reduced by placing implants under the muscle. I personally would not complicate matters by fat injections, which can have their own consequences. It's rare to see rippling on the lateral aspect of the breast unless you are bending over at the waist. This is inherent in performing an augment on a very thin individual. I would not advise you to gain weight as there is no certainty that this would increase breast size. Some physicians have had success with Alloderm.

Rippling after augmentation may be related to the thinness of your skin but it's certainly a possibility that mild contractures exist.  If the implants are textured gel implants and not smooth I have seen more rippling in those patients and on occasion have reoperated on the patient and switched to a smooth gel implant.  It's probably not an issue with the muscle not being big enough as patients with smooth gel implants above the muscle often look very nice.

The truth is that all implants, both silicone and saline may ripple in individuals with very thin cover. First, you should make sure that your implants are indeed under the muscle. Also, with cohesive implants, if pushed through too small a breast incision, 'fractures' in the cohesive gel may form and distort the implant shape with ripples in the covering. So four things to consider; submuscular, smooth undamaged implant, perhaps higher implant profile, an allograft, in that order.

Best of luck,

peterejohnsonmd

Because you have a low body fat count the muscle and tissue can only hide some of the "ripples". Best to try and gain weight or a fat graft , if you have any fat to the areas could help. 

I would make sure your implants are placed submuscularly - if not, that would be a solution.  Another reason you may have rippling is that the weight of the implant is weighing down your natural breast tissue - often Alloderm or other dermal matrix can be used to create an internal bra to hold the implant weight on the chest wall.  Good luck!