Severe Rippling: Overfilled Saline or Silicone? (Photos)

Question

I am a very thin patient with severe rippling from 10-year-old saline implants. My main goal is to reduce rippling as much as possible. For patients with very little tissue coverage, which generally gives better results: overfilled saline or modern silicone implants? Any advice or experience with similar cases would be greatly appreciated

Daniel Barrett, MD · Answer

Dear ipoltava,
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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. You definitely have what I term "slide down " which is inferior descent of the whole breast and implant.  Many times this is associated with implants on top of the muscle which you is why you have significant wrinkling as well.  In your case, I would perform a reposition of the implants under the muscle With silicone implants and a lift. This will elevate the breast on your chest and diminish the wrinkling significantly.  I have been in practice for over 30 years and revisionary breast surgery is a large portion of my practice.  You should be able to have an excellent result.  Best wishes to you.

Gregory A. Buford, MD, FACS · Answer

As a Board Certified Plastic Surgeon who specializes in revision breast surgery, I see a good number of patients with rippling like you.  To that, it would be helpful to know if you are over or under the muscle because that can make a difference.

My suggestion would be to AVOID saline implants.  The look fake, feel fake, and they have a higher tendency to ripple than their silicone gel counterparts.  I would highly recommend either the Allergan Cohesive implant or the Motiva Ergonomix.  I would also consider use of a bioresorbable scaffold (such as Galaflex 3DR) to help support the implant but also reduce the appearance of the rippling.

This is a more complex case so make sure that you consult with a Board Certified Plastic Surgeon experienced in secondary breast cases.

I hope that helps and wish you the very best!

Yasemin Aydinli, MD · Answer

In a thin patient with very little soft-tissue coverage, rippling is one of the harder problems to solve, and modern cohesive silicone implants generally give better results than overfilled saline. Saline implants ripple more by nature because they are essentially a fluid-filled bag; overfilling reduces it somewhat but firms the implant and doesn't reliably eliminate the visible and palpable waviness when there is minimal tissue to hide it. Highly cohesive ("gummy") silicone gels hold their shape and feel more like natural tissue, which is why they are usually preferred in this situation. Given that you are thin with thin skin, I would lean toward a smaller, lighter silicone implant rather than a large one &mdash; a lighter implant is also more durable in the long run, because it puts less stress on your thin skin and does not stretch it as much over time, which both prolongs the result and shows rippling less.
The implant choice is only half of it; the other half is coverage. If the implants are above the muscle, moving to a submuscular or dual-plane position adds muscle over the upper pole where rippling shows most. Reinforcing the soft-tissue envelope also helps &mdash; this can be done with acellular dermal matrix (ADM), or with newer-generation meshes such as GalaFLEX (P4HB), which support and thicken the tissue over the implant. Fat grafting to the cleavage and upper pole is also very effective for camouflaging rippling in thin patients and is often combined with a silicone implant exchange in the same operation. From your photos, your skin also appears quite stretched, so it looks as though you may also need a lift (mastopexy) to tighten the envelope &mdash; this usually improves both the contour and the way the tissue drapes over the implant.
The best combination depends on the current implant position, pinch-test tissue thickness, and the amount of available donor fat, so a revision-focused evaluation by an experienced plastic surgeon is the right next step to decide between cohesive silicone, a pocket change, mesh or ADM reinforcement, fat grafting, and a possible lift.

Camille Cash, MD · Answer

Rippling and wrinkling can happen with both saline and silicone implants, though silicone seems to have a lower occurrence.  Another layer to address this is for the implants to be placed under the muscle.  The muscle will act as a camouflage for the upper outer quadrant of the implant.  I've included a video that I hope you find helpful.

Severe Rippling: Overfilled Saline or Silicone? (Photos)

Answers (5)

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