Can silicone rippling be eliminated with further surgery? Fat transfer, change in implant type/style/material/size/etc? (Photos)

5'2, 115lb, no kids, had surgery over 1yr ago, went from a 32B/C-32D using 495cc Natrelle INSPIRA smooth/round Extra-full projection, under muscle via inframmamary incision. I went with SILICONE INSPIRA because they said it had a lower rate of rippling. At first there was no ripples at all and everything felt smooth, but by month 6 After surgery side rippling began to develop and it has increasingly worsen, and now slightly under my breast too. I was also left with a 2.5in horrible Wide cleavage

Doctor Answers 6

Can silicone rippling be eliminated with further surgery?

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 I am sorry to hear about the problem you are experiencing.  Some patients benefit from adjustment of the breast implant capsules (capsulorraphy); some patients benefit from the use of additional supportive/coverage material such as acellular dermal matrix.  It will be important for you to seek consultation with board certified plastic surgeons who can demonstrate significant experience achieving the types of outcome you are trying to achieve. You may find the attached link, dedicated to this type of revisionary breast surgery, helpful to you as you learn more. Best wishes.

Implant rippling

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Just to be clear, ALL implants ripple. Saline more so than silicone, but it is clinically significant if you can see it. When you do it is a combination of thin skin with minimal subcutaneous fat as well as paper thin scar tissue capsule forming around the implant.A fat grafting procedure or a sheet of acellular dermal matrix would give you the best chance of improving your situation.Good luck!

Sam M. Sukkar, MD
Houston Plastic Surgeon
4.6 out of 5 stars 40 reviews

Options to minimize implant rippling

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Implants will show rippling when the tissue coverage is thin, and it is usually more noticeable on the outside and bottom where there is no muscle coverage. Although Inspira implants ripple less than other round implants, the higher the profile the more likely there will be rippling, with any implant. Form-stable (gummy bear) implants ripple the least but are not ideal for everyone. You may benefit from an internal bra with Strattice or Galaflex. Fat grafting is not very reliable for this type of rippling.

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

Causes and correction of implant rippling

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I am sorry to hear you are having to deal with these issues after your surgery.  There are a couple of issues to discuss and the first step would be seeing your board-certified plastic surgeon or one who is comfortable with breast revision surgery.  The wide cleavage you are complaining of is a result of two issues, one is that the implant you and your surgeon chose is maximally projecting, and therefore, maximally narrow for its given volume.  The other issue is that the implant is positioned under your muscle, and so it is limited in being able to move towards the mid-line by the muscle's attachment on your sternum.  The effect could potentially be improved by moving the implant in front of the muscle, and choosing a wider implant.  (You may not like this implant shape, and rippling will be worse because now the implant will be closer to the skin's surface, i.e. less coverage)The second problem you mentioned is the rippling--this is due to the implant shell/gel movements and your thin tissues.  The rippling tends to worsen as tissues this with age, and the implant shell stretches over time.  So, the two ways to correct this are to choose an implant which ripples less (a cohesive gel, gummy bear-type implant) and to improve the soft-tissue coverage. In general the techniques to improve thin soft tissue include fat grafting and/or acellular dermal matrixes (Alloderm, FlexHD, Strattice, etc).  My preference in these situations is to use a cohesive implant which is firmer but wrinkles less.  I also like to thicken the tissues with ADM and fat grafting.  You may want to discuss these options with your plastic surgeon to see if you are a candidate for any of these techniques.  Best wishes,-- Erik Hoy Rhode Island Plastic Surgeon

Erik Hoy, MD
East Greenwich Plastic Surgeon

Rippling laterally is hard to "fix"

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Thanks for your question and the photos. I'm sorry for your issues. The lateral rippling is frustrating and hard to "fix". There is just no muscle to help camouflage the implant. Given your petite frame and lack of fat under the skin it becomes even more pronounced especially with such a large implant that stretches everything out. Fat grafting is one thing that gets discussed, but there is not much space between the skin and the implant pocket to put fat. One option, although costly, would be to use Strattice. Best of Luck

M. Scott Haydon, MD
Austin Plastic Surgeon
4.8 out of 5 stars 93 reviews

Difficult problem

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Hello,Part of the problem is that the tissues overlying the implant are thin.  The two options to consider are:1. Fat transfer2. Biologic mesh placement at the lower pole of the breasts.You may need both treatments.These may improve, but may not totally resolve your issue.
-Dr. Chike-Obi

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