Under the Muscle Saline Implants Rippling?

Breast Implant Rippling most often occurs when there is insufficient soft tissue coverage due to little overlying body fat and breast tissue. Implants placed beneath the muscle help to minimize this phenomena but the lower and outside breast (as pectoralis muscle is no longer present), towards the cleavage where the muscle thins out or on top of the breast where breast tissue is often lacking are the most common places to see rippling. It is often accentuated with certain positions (e.g. bending over,or leaning). Most of the time, rippling is felt along the outer side of the breast and the inner side of the breast next to the cleavage. Breast implant waviness (rippling) that is felt but not noticeable to the eye is very common and should not be a concern. However, when rippling is visible, patients are often self-conscious about their appearance.Factors that are associated with increased rippling include:Traditional Saline implants (IDEAL® Saline implants less likely)Textured implantsLarge implantsThin patients with low BMIImplants placed above the musclePrior history of ripplingFactors which are less likely to have rippling include:Heavier and larger breasted womenUsing a highly cohesive form-stabile silicone implants (gummy bear)Smooth implantsSmaller implantsSubmuscular placementOnce rippling occurs it is very difficult to correct. Rippling can be minimized by placing a biologic fabrics (e.g. AlloDerm®, Strattice™, SERI®), submuscular conversion if implants are above the muscle, fat transfer, use of adjacent tissue (muscle or fascia) if available, and in persistent cases implant removal and fat transfer. Seek the care of the best board certified plastic surgeon possible with experience in breast revision surgery.#rippling#breastaugmentation

Hello! Thank you for your question! Breast augmentation is a procedure often sought by women to increase size, add upper pole fullness and projection along with improve shape and symmetry of her breasts. Women who have the breast augmentation done report increased self-confidence, self-esteem, and more comfortable with her body. In fact, it has been the most popular procedure in plastic surgery in the US for the past few years. In general, implant size does not correlate with cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size or implant size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance. Your breast width is the most important measurement. Things to to consider during your consultation, which your surgeon will discuss with you, include implant type (saline vs silicone), shape/texturing of implant (round vs shaped/textured vs non-textured), implant position (sub pectoral, subglandular, or subfascial), incision (inframammary fold, periareolar, axillary, or TUBA), and size of implant. This can be performed with/out a breast lift, which would serve to obtain symmetry in breast size or nipple position as well as improve shape. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory. I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width. Too large of implants for the woman often destroys the breast pocket and breast shape, thus creating an oft seen uncorrectable problem later. Very slightly less tissue may be visualized with subglandular implants, but not very significant.Implants may be placed either in the subpectoral (beneath muscle) or subglandular/subfascial (above muscle). Both locations are excellent and you can choose either one - your surgeon will discuss the pros and cons of each. In general, while a placement above the muscle is a more natural position for an implant to augment the actual breast, I find that it is not desirable for very petite women or women with a paucity of breast tissue - as the visibility and potential rippling seen/thinning of tissue may give a suboptimal outcome. A subpectoral pocket adds additional coverage of the implant, but causes slightly more and longer postoperative pain/swelling as well as the potential for animation deformity with flexing of the muscles. Today, there is no virtually no difference in rupture rate, capsular contracture rate (slightly higher with subglandular as well as certain incisions), and infection with the positions. As you see, there are a few factors to decide upon for incision, placement, and implant type/size. Consult with a plastic surgeon who should go over each of the options as well as the risks/benefits.   Riipling is always an issue - silicone or shaped silicone implants would have less rippling, or consideration for placement of a dermal matrix or fat grafting if it appears later.Hope that this helps! Best wishes for a wonderful result!

Thank you for your question. Rippling can be seen when the surface of an implant shadows through the tissue, often found where the breast tissue coverage is thin. It can happen in one or both breasts. Some implant styles are more prone such as an overfilled saline implant. Others are less prone such as a shaped silicone implant. So one approach is to choose an implant to one that is less prone to rippling. Another approach would be to add some thickness to the breast tissue. This can be done by fat grafting where fat is carefully layered between the skin and the implant. Another is to add a dermal matrix sheet between the breast and the implant where the rippling is visible to blunt the impression of the implant on the overlying skin. I would visit with a board certified plastic surgeon to discuss your options in more detail.

Great question.  Rippling is a function of the implant placement, type of implant, and anatomic characteristics of the patient.  I would personally advise you to choose silicone implants to maximize your chance of success. 

This is a fantastic question and one I hear everyday from patients with very similar physical characteristics such as yours. Patients with very little breast tissue desiring breast enhancement will rely on the implant and its volume to fill the desired cup. In other words, there will be very little soft breast tissue between the skin and the implant to protect against "rippling"....Both saline and silicone implants can ripple; silicone ripple less. 

Rippling can be either something you can feel (usually in the lower/ outer aspect where the muscle will not cover when the implant is placed under the muscle) or seen.

I suggest you speak with your Board Certified Plastic Breast Surgeon who specializes in breast augmentation as they will be able to educate you more accurately after they are able to assess your skin and breast tissue directly. This will help individualize your decision.

I hope this helps!

Good Luck....

Dr. C

I usually recommend going under the muscle with saline or silicone breast implants as I believe it achieves a more natural look. That being said, being so thin with little breast tissue makes it more likely that you will notice rippling. Silicone implants have been known to show rippling less often then saline. Talk with your surgeon about your options and the differences between the two types of implants and the placement.

If you're thin, silicone implants are less likely to show contour irregularites than saline filled.  Even though they cost more, I think you should go this route.  Even though you are convinced below the muscle is better than above, when silicone gel is the implant of choice, there is no difference in contour problems above or below the muscle.  Nothing wrong with going below, but want the facts straight.

 

Not to put a cloud on your process but you could have rippling no matter what type of implant you chose. The key is your body fat! So stay in shape but understand that at the lower and lateral portion of your breast, the implant is actually subcutaneous. So, this is where the rippling can be seen and or felt. The only other possible option is to have your saline implants filled to the maximum. However, this does lead to a more firmer feeling breast, but less chance of rippling. The choice is yours.

With very little breast tissue you are more likely to see rippling. Silicone implants ripple less than saline. Many surgeons actually recommend silicone implants for very thin women. It is advised that you speak with your plastic surgeon to go over your best options.

Rippling can happen with under the muscle or over the muscle but is less likely to occur under the muscle.