Options for rippling with implants after preventative mastectomy? BMI 22, are there any other options out there?

This is a challenging problem to address for slim patients with implant based reconstruction. Some options include changing the implant plane to submuscular (if they are not already beneath the muscle), using an implant with a more cohesive gel to reduce the appearance of implant folds, use of an acellular dermal matrix to provide an additional layer of coverage, or fat transfer (but this is limited by the donor fat that you have available). It would be worth discussing these options with a plastic surgeon specialising in reconstructive breast surgery.

Usually even in very thin women there is some place to harvest fat. Sometimes you have to get a little bit creative with where you remove it. Fat can be removed from arms, legs, thighs, flanks, tummy, etc. I prefer to use stubborn fat rather than have women gain weight because fat tends to retain the characteristics of where it came from. If you gain weight for fat transfer and then lose the weight, you are likely going to lose the fat from your breasts as well.
In women will less fat to harvest there are also newer products that can be mixed with fat that contain components of fat, ex) Renuva that can be combined with fat to increase volume.

Thank you for your question.
Fat grafting is a very suitable option when it comes to improving the appearance of breast implant rippling. This fat can be harvested from the abdomen, flanks, and other regions with this tissue. Without photos or an evaluation, it is quite difficult to say if you are a candidate for this procedure. I recommend speaking to your plastic surgeon to discuss your options and concerns.