Visible Rippling Just 3 Days Post-op, Possibility of Getting Better? (photo)

Question

I have 330cc silicone implants placed over the muscle. I had very little native breast tissue in my upper pole, and am 5'2" 115 lbs. I'm already seeing rippling 3 days post op. Help! It's in the middle of my chest, where the skin has stretched the most. Is there any chance that this will improve and that the rippling is actually due to the skin being swollen and stretched too tight? Any chance this could get better as the implants settle or will it only get worse? Thanks for your help.

Steve Laverson, MD, FACS · Answer

Notwithstanding the excellent answers of other responders, visible and/or palpable rippling on the surface of augmented breasts may result from a variety of factors, and management of the problem depends on which   factors apply in your case.  Your pre-operative skin excess (increased breast surface to volume ratio) does not appear to be completely corrected by augmentation alone.  Pocket size, if too small, may cause a fixed wrinkle or ripple.  Skin thickness, implant placement, textured vs. smooth implant surface, amount of breast gland over the implant, and implant size all influence the development of skin surface rippling.  Your result will evolve as healing progresses.  The implant-tissue interaction is dynamic.  Your surgeon is best positioned to help manage this problem at the present time.

John J. Corey, MD · Answer

Probably the only chance you have for this to resolve on its own is if the capsule that will form over the next few months gets a bit tight. I have seen that put enough pressure on the implant to help &ldquo;iron&rdquo; out some of the wrinkles, but that is rare. So I would give it time and see if you get lucky and that happens, but from your &ldquo;before&rdquo; pics I would say that to go under the muscle, you would have needed and would still need a lift..Implants in thin women does cont to be a challenge..

Howard Webster, MBBS (Hons), FRACS · Answer

Hi there:

	Are you really only 3 days postop?  Your breast appearance is more consistent with a longer term result, and it would be truly remarkable for you to have the photographed appearance at 3 days postop.  I'm not saying you're wrong - but it's important for you to confirm that this detail is correct in order to properly advise you.

	The good news is that the lower poles look good and the implants are appropriately positioned.  The bad news is that for a really good outcome, the pocket will need to be changed to subpectoral for better upper pole coverage.

	I am an advocate for implants on top of the muscle in the subfascial plane, so I support your surgeons advice to put implants above the muscle as he/she has, especially as you have mild droop on your preop picture.  However, with the best of intention and experience, a revision is occasionally needed to optimise the result and you will need that in my opinion.

	It doesn't matter if your implants are saline or gel in that event.

	Good luck.

Christopher V. Pelletiere, MD · Answer

Unfortunately, once someone has a ripplin issue with the breast/implant, it does not get better on its own.  Rippling is simply the result of the tissues being too thin to fully mask the device itself.  Because of this, you see the folds of the implant through the tissues.  This is the reason that it is nice to place the implants submuscular when possible.  Adding a little bit of extra tissue between the outside world and the implant helps.  It is not perfect, but it can improve palpability and rippling issues.  I hope this helps.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.

	No unfortunately, I do not expect the rippling to improve with time. The rippling is related to the fact that you did not have much &ldquo;coverage&rdquo; in the superior and medial aspects of the breasts. 

	Some general  thoughts regarding rippling may be helpful...Palpability  and rippling of breast implants may be related to several factors. These include the amount of soft tissue and breast tissue coverage over the breast implants, the position of the breast implants (submuscular versus sub glandular), the type of implants (saline versus silicone), and the degree of overfilling of saline filled implants. Generally, weight loss will extension weight any rippling/palpability  of the implants.  Deflation of the implants will also increase the rippling/palpability of the implant.

	Correction of the rippling may involve further surgery including implant pocket exchange if possible ( sub glandular to submuscular), implant exchange if possible (saline to silicone), and/or the use of allograft to provide an additional layer of tissue between the implant and the patient's skin. Patient weight gain (if possible) may also be helpful.  

	Please make sure you are working with a well experienced board-certified plastic surgeon since revision surgery may become necessary.

	I hope this helps.

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