43, 5'8, 136lbs, 385 & 355cc too big & rippling, what is possible for my situation? (Photos)

Of course you have problems with implants placed over the muscle. The simplest solution would be to change your current underfilled Sientra implants with either Natrelle Inspira with their cohesive gel or, my preference, with Motive Round implants (the higher cohesive of the two gels they offer). This is not a sure thing, but ripples should be improved. Alternatively, get a more invasive revision surgery to place implants under the muscle, where I think they belong, even in young, athletic people.

Dear betterthanbefore,
Breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

At this time, I recommend removing the implants and doing a circumareola lift to move the nipple-areola complexes more medially. You will also need plication of the capsules inferiorly and laterally to place the implants higher and more medial. I also recommend the retro-pectoral position. A new pocket can be more stable then trying to plicate the old pocket. I recommend smaller silicone implants for less rippling than saline implants.

Best Wishes,

Gary Horndeski, M.D.