Should I switch from saline to the new highly-cohesive implants to address rippling and softness?

I have extremely thin tissue and got saline implants two years ago. As my doctor predicted, I have visible rippling from the saline. They also do not feel very natural. I am considering switching to the new highly-cohesive implants (Allergan 410). Will the anatomical shape "stay put" in my current pocket, or is there greater risk of malpositioning due to it being a replacement? Will they be softer than my currently overfilled saline implants? Would I have better luck switching to conventional silicone?

Doctor Answers 5

Will HIghly Cohesive Form Stable Implants Solve My Saline Implant Rippling Problems?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Highly cohesive gel implants are not round, but shaped. This means they require a pocket, dissected for the first time in a breast without a pre-existing capsule, that is just as big as the implant. The idea is that the asymmetrical implant should adhere and be controlled by this close-fitting pocket so it will not rotate. Putting it in a pre-existing pocket goes against this principle. Theoretically, if there were a small pocket and the lining was removed, the new pocket might be small enough, but I doubt this occurs much in practice. Alternatively, if the old implant were above the muscle, that pocket could be closed off, and a new pocket made below the muscle. That is easier said than done, as closing off a subglandular pocket may not be possible without causing distortion or puckering of the overlying skin as it is reattached with sutures to the underlying muscle.
In terms of softness, a highly-cohesive form stable gel implant is definitely firmer than a saline implant, and in fact all three manufacturers' implants are firmer than the regular cohesive shell implants. Some women do not like the firmness of the newer form stable implants and opt for the regular soft gel implants when they examine these implants side by side.
Conventional silicone will not cure all rippling, particularly in thin-skinned patients. The shell can sometimes be felt, or felt as a knuckle of soft implant pushing outward. It is still an excellent alternative for the patient with excess, undesirable rippling with a saline implant, and women seem very satisfied with the difference.

Mountain View Plastic Surgeon
5.0 out of 5 stars 54 reviews

Unhappy with Rippling in Saline Implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Saline Implants can appear more unnatural than silicone, particularly in thin women.  There are a number of ways to improve your result.  The change should be INDIVDUALIZED to your circumstances.  You might need to have them placed beneath the muscle, you might be better served with a gel implant, either round or the highly cohesive  shaped Allergan style 410.  There are pluses and minuses to each choice.  Your best advice would be with a personal consultation so that you can consider choices carefully and your surgeon can give you choices, specific to your body and your goals.  It is an important decision.  You want to be happy the second time around!

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 117 reviews

Switch to Highly Cohesive Shaped Implants to Address Rippling and Palpable Implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

If you have extremely thin tissues, the Highly-Cohesive Allergan 410 may not be the optimal choice for you. The rippling and softness are somewhat separate issues. It is true that gel implants in general tend to have less visible rippling, but getting a gel implant is not a guarantee that you will not have visible rippling. Although the Allergan 410 is a very cohesive implant, and thus less prone to rippling, it is also a very firm implant and thus not likely to be a lot softer. It will feel different, but firm. The Allergan 410 is the most firm of all the manufacturers of highly-cohesive shaped implants, so it would not be my first choice.

Also if you should choose to go with a shaped implant then there is the risk of implant rotation which is a problem for an "anatomically" shaped implant. To prevent rotation the implant surface is textured so that it adheres to your tissues when it heals, which helps prevent rotation. But if you already have an implant in place, then your body has developed a capsule around the implant. A new shaped implant will not adhere to a capsule, so you will need to have a near total capsulectomy if you want to minimize the chance of having your implant rotate. Having a capsulectomy means further thinning of your already thin tissues, something only to be undertaken with great caution. And, if your were to have a capsulectomy, you would need to upsize your implant a good amount so that implant fits tightly within the pocket to ensure optimal adherence. As you can see, there are a lot variables here and it is not quite so simple as just exchanging the saline for a shape gel implant.

There are also other strategies available to address the problem of thin tissues. These could include placing Strattice or Seriscaffold on the inside of the implant pocket to, in effect, thicken your tissues and reduce the palpability of the implant. There are pluses and minuses with each of these materials. Another alternative would be to thicken the tissues around theoutside of the implant by doing Autolgous Fat Transfer. All of these options have risks and benefits and need to be discussed thoroughly with your surgeon, and you should choose someone who is very experienced at doing revisionary breast surgery.  

Options for rippling with saline implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
The 410 highly cohesive gel implants do tend to ripple less but there are several issues to consider: If you have thin coverage, they may not look or feel more natural. They will be prone to rotation unless a total capsulectomy is done, which will reduce coverage even more. Round gel implants will probably feel more natural but will not reduce rippling as much. For many cases of rippling, the best solution is to add coverage with an internal bra using materials such as Strattice or Seriscaffold.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Should I switch from saline to the new highly-cohesive implants to address rippling and softness?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
It is not possible to provide you with specific enough advice to be very helpful. Some general options available for patients in your situation include conversion of sub glandular to sub muscular breast implant pockets, the use of silicone gel breast implants, and/or the use of acellular dermal matrix to help with the concerns of breast implant rippling. I would share your concerns about the possibility of breast implant rotation, with the use of anatomically shaped breast implants.
Select your plastic surgeon carefully and make sure that the type of silicone gel breast implant use is indeed “soft” enough to achieve your goals.
Best wishes.

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.