What Procedure Will Remove the Rippling and Increase my Breast Size?

I had a breast aug. in 3/2008 with saline impants filled to 465cc over the muscle. I loved the results. Since then I have had another baby and breast fed. Now I have rippling(my main concern) and slight sagging. Some doctors suggest under the muscle whith a lift others say to stay over the muscle with saline implants. I want to be bigger and want to know what would work best for me? I would really like to avoid a lift if at all possible.

Doctor Answers 22

Bad result from implants on top of the muscle

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Your photographs should be an educational poster as to why implants belong under the muscle.  You have severe capsular contractures causing hard spherical breasts that sag too much. In my opinion, your best opportunity for a long -term good result is a three step process.  Have your implants removed. Wait for several months and then have a breast lift. After you have recovered from this, have larger implants placed under the muscle.  I have treated a number of women with similar conditions with this three step process and all of them are very happy with their results. Bigger saline implants on top of the muscle will only add to your problem with more rippling and more sagging.

Columbus Plastic Surgeon
4.8 out of 5 stars 40 reviews

At some point a lift is unavoidable in breast augmentation.

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   Your desire to go larger is your choice I guess.  You wiill need a lift and the implant must go under the muscle.  Saline implants overfilled will work nicely and I actually prefer them in yur type of anatomy but the gels will do well also.  To simply stuff in larger implants will be unwise.  Talk to 3 ABPS FACS Surgeons.

Revision with support

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I would recommend subfascial augmentation with silicone implants as this isvthe only way to establish the support that you need at this point

Rippling associated with breast implants

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Based on your pictures, the best option would be to place silicone implants in the submuscular position.  By placing the implants in the submuscular position, the rippling will be masked by increased soft tissue coverage.  Increasing in size and the need for a lift would be better discussed in person with a board certified plastic surgeon.

Naveen Setty, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 78 reviews

Misshapen breast after breast implant and capsular contracture

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Your photos show capsular contractures with sharply visible implant edges and rippling of the upper half of the implants especially on the left. The rippling is visible because there is not alot of tissue between the upper half to the implant and the outside world. Also there is vertical distortion of the nipple complexes and the left breast is larger than/droops more than the right. If you just replace the implants with larger saline implants placed on top of the chest muscles you will clearly make these problems much worse. Your best bet are silicone cohesive gel implants most likely placed under the muscle and slightly smaller than you current implants.

From the photos alone it is difficult to say whether or not you would need a simultaneous lifting procedure or what pattern of skin excision would be best for the lifting procedure.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Breats revision following augmentation

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You have multiple issues that are apparent from your photos. These include:

1. breast mound positioned inappropriately low

2. tightening of your capsule around the implant

You need to have implants removed, breasts lifted to a proper position so that your breast mound extends naturally from your chest wall, and to replace your breast implants in a subpectoral position.

Arian Mowlavi, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 108 reviews

Implant issues

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You may want to consider under the msucl efor more soft tissue coverage in the upper pole. As for a lift, I would have to examine you.  You  may be lucky to just need a circumareola lift or possibly a vertical lift..

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

What Procedure Will Remove the Rippling and Increase my Breast Size?

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I would strongly recommend Silicone gel behind the muscle.  Be sure you consult with a Board Certified Plastic Surgeon who understands the importance of choosing the right profile implant so that you have less of a risk of rippling.  If you have too large an implant, your rippling risk is still high.  Peri-areola mastopexy can be nearly a scarless lift, and can give you a little skin tightening and lift your nipples up giving you a better cosmetic result.  But for your best results, a complete lift would be a better choice.  Strattice is also a good option for larger implants.  Good luck!

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
4.9 out of 5 stars 109 reviews

Severe rippling and deformities from saline implants above the muscle

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Your situation is an extremely common one that I see here in Scottsdale and one that could have been avoided. (In fact, I had a patient in my office just today with an identical problem!) For many reasons, saline implants placed above the muscle (especially larger ones like yours) virtually always lead to very inferior results including severe rippling, stretching and thinning of the skin, with drooping and other deformities.

There are a few possible approaches that can provide you with a far more natural appearing and feeling breast. Ultimately, you would do best with silicone implants placed behind the muscle preferably with a 2 stage approach. There is also a high probability that you would require a lift to provide you with the appropriate contour though I understand your hesitancy to undergo this because of the additional incisions. These issues and more can be discussed in the office.

There are ancillary techniques available that can assist in providing more support and thickness for your tissues including the use of Alloderm or Strattice which are acellular dermal matrix materials. The big problem with these is the exorbitant cost which runs thousands of dollars - making it somewhat prohibitive for most patients paying out of their pocket.


Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 reviews

Breast revision question

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You will get varied answers depending on the plastic surgeon but my advice would be a site change to partially under the muscle with a change to silicone gel implants accompanied by a breast lift. This will provide the best option to decrease upper breast rippling, improve shape and rejuvinate your breasts.

I hope this helps

Dr Edwards

Note: Dr. Edwards cannot give advice about specific medical problems nor should answers provided by Dr. Edwards be substituted for a complete medical history, work-up and an in-personal medical/surgical consultation.

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.