What is the Best Implant for my Secondary Surgery?

I had subglandular BA in May 2012 with 360mm textured teardrop natrelle implants (13cm width). I have visible rippling since 4weeks mainly in cleavage area. My surgeon attempted fat grafting with no success. I am very thin and have a loose breast envelope with minimal breast tissue after kids and breast feeding. My breast widths are 12 and 12.5. I have been advised to have larger volume smooth inspira implants. Is this an easy exchange? Is there a higher risk for problems verses the primary?

Doctor Answers 8

Rippling post augmentation

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Amy I am not familiar with smooth inspira implants,and you didnt say if your present implants (textured natrell implants) are saline or gels. I think the best solution is getting more tissue between you and the world. I would try a mentor moderatly high profile smooth gel implant under your pectoralis muscles. Wether to use a dermal substitute or more fat grafting would be another decision because you can still have wrinkling with a silicone implant, your doctor would have to make that decision and have plan a and plan b going into surgery.

Lafayette Plastic Surgeon

How do I fix rippling of my breast implants?

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Rippling after breast augmentation can result from several factors including:

  • placement of the implant (subglandular vs. sub pectoral)
  • type of implant (saline vs. gel)
  • size of the implant (large vs. small)
  • amount of pre-existing breast tissue (small amount vs. large amount)

The first factor in each of these variables tends to increase the risk for rippling and so these would be areas where you could start to address this issue.  


A basic approach at this point could include conversion of your gel implants into a subpectoral pocket followed by either fat grafting (to the very thin areas), use of Strattice, or both.  I would definitely discourage you from upsizing your implants and would also look at a smooth round implant since there is really no benefit to texturing of the implant when it is below the muscle. 


I hope this helps!

Teardrop Implants in Subglandular Plane

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        The rippling can be improved by submuscular placement, fat grafting, the placement of a dermal matrix, switch to a smooth silicone implant and appropriate pocket dissection.  Kenneth Hughes, MD Los Angeles, CA


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Rippling occurs with thin coverage over the implants. Sometimes placing them under the muscle is the way to go. Also strattice coverage may help as well.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Change the characteristics of your augmentation

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There are, essentially, four characteristics to decide upon with breast augmentation.  1.  What size or shape you desire 2. What kind of implant to use (saline implant vs. silicone implant, smooth implant vs. textured implant, teardrop vs. round implant) 3. Where the implant should go (above the muscle or below the muscle) and 4. Where to put the incision.

When something isn't right the first time, these are, essentially, the four things that can be changed to get things how you desire.  Your specific issues are likely addressed by changing number 2. What kind of implant and 3. Where the implant sits.  It is generally accepted that ripples are more easily felt with any of these three characteristics: Textured implants have wrinkles that are more easily palpated than smooth, Saline implants have more palpable ripples than silicone implants, and implants above the muscle are more palpable than implants below the muscle.

To address your issues a reasonable plan would be to move the implant below the muscle as a smooth saline implant or, to lower your risk further, below the muscle with a smooth silicone implant.

The exchange is not especially difficult in most cases but the the texturing might make the capsule around the implant a little harder to deal with.  Otherwise.  Most anyone who has done a fair number of breast augmentations should be pretty comfortable with this procedure.

Best of luck,

Dr. Pyle

Jeremy Pyle, MD
Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 125 reviews

Breast implant revision choices

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Although you didn't say specifically, it sounds like your implants are above the muscle.  A submuscular conversion should help with the ripples in the upper inner quadrant and a smooth walled implant using silicone gel is usually better.  All this needs to be sorted out in person with your chosen doctor.

What is the Best Implant for my Secondary Surgery?

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Ripples are somewhat less likely with smooth vs textured implants, and with silicone vs saline implants.Given the position of ripples in the cleavage area, I think the best thing you can do is have the implants moved to the submuscular position. I am really not sure why a larger volume would help the situation. 

Thanks, all the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Best Breast Operation for Subglandular Breast Implant Rippling?

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Thank you for the question.

 Given your description of body type and breast implant “rippling”, you may want to rethink the surgical plan. The relatively simple removal/replacement currently planned may leave you with the same issues. However, re-augmenting the breasts with the breast implants ( preferably silicone gel) in the sub muscular (dual plane)  position will be more likely to help you with the rippling issues you are experiencing.  Sometimes the use of a acellular dermal matrix is also helpful.

 You may want to discuss these options with your plastic surgeon and/or seek additional opinions with well experienced board-certified plastic surgeons in your area.

 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.