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Why do I have Rippling after breast lift/breast augmentation?

Q:

I recently had old implants (saline) removed and new ones (silicone) replaced along with a lift (areola incision). I have severe rippling on one breast at top/mid section. They are Natrelle Silicone filled style 20 (smooth texture). I didn't have rippling before and went up in volume from 325 to 350 cc. Is it the Dr's error and what can I do to correct? He said he also put a mesh in place? The procedure was very expensive and I am very disappointed/dissatisfied.

A:

All breast implants ripple and saline filled implants ripple more than silicone gel implants. The question is can you feel or see the ripples. It sounds like you probably had capsular contractions around you old saline implants which prevents the ripples form being felt or seen. When your surgeon replaced the saline implants with gel filled implants you most likely did not develop capsular contraction. Since you have ripples now it is because there is not enough soft tissue over your implants to prevent you from feeling and seeing the ripples. If your implants are under the breast then they could be moved under the muscle and this may give enough soft tissue coverage to prevent the ripples from being felt or seen. Another way that I will often address the ripples is to do fat grafting of the breast in the areas of the ripples. This not only with thicken the soft tissue coverage and hopefully prevent the ripples from being felt or seen. It will also give you a fuller nicer breast. 

A:

 

 Post operative folds and wrinkles especially in the medial position following breast augmentation/ mastopexy augmentation can be a very difficult and expensive concern to correct. There are several approaches that can be taken to include fat grafting, relocating the implant under the muscle, synthetic dermis insertion, etc. Often synthetic dermis can be required to assist in definitive  correction. Sheets of this material start at $2,500 with the average price for a large sheet being $3,000. Sometimes two sheets are required per side. Consider returning to your surgeon to address your concerns. If you are not satisfied with their plan of action then, consider a consult with one of the many members of the ASAPS in your area for other options.  Best,

 

  Gary R Culbertson, MD, FACS

A:

Rippling is not unusual with either saline or silicone gel implants.  The visibility or palpability of the rippling is likely do to the paucity of soft tissue coverage over the implant in the area of concern.  Sometimes gaining five pounds or so will help hide the rippling by increasing the fatty tissue coverage.  Alternatively, using high profile, ultra high profile or shaped silicone gel implants may help decrease the risk of recurrent rippling.  I'm not sure what type of "mesh" was placed, but the use of synthetic products (artificial dermis) like Alloderm or Strattice, which are expensive, may help hide the rippling by adding a layer of material between the implant and overlying soft tissues.  You should discuss your desires and concerns with your surgeon and/or obtain a second opinion from another board certified plastic surgeon and/or member of ASAPS.  www.drtoddcase.com

A:

I understand your disappointment and am sorry to hear of your experience. Fat grafting is an excellent technique to camouflage rippling of a breast implant. Please discuss with your plastic surgeon. I am sure he or she is also disappointed and wants you to be happy.

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