Breast augmentation is a popular cosmetic procedure aimed at enhancing breast size and shape. However, like any surgical procedure, it comes with potential complications. One such complication that can cause concern and dissatisfaction is breast implant rippling. This article provides a comprehensive overview of breast implant rippling, exploring its causes, preventive measures, and available solutions.
What is Breast Implant Rippling?
Breast implant rippling refers to the appearance of wrinkles, folds, or ripples on the surface of breast implants that can be seen or felt through the skin. It is a common complaint, and while not a medical threat, rippling can negatively impact a woman's confidence and self-esteem. Women may become self-conscious about their appearance, especially in revealing clothing, which might make them regret undergoing the procedure.
Causes of Breast Implant Rippling
Several factors can contribute to breast implant rippling. Understanding these causes is crucial for both patients and surgeons to make informed decisions and minimize the risk of this complication.
Implant Type
The type of implant used plays a significant role in the likelihood of rippling.
- Saline Implants: Saline implants are generally more prone to rippling than silicone implants. All saline implants, no matter their fill volume, will have a greater chance of rippling than silicone implants. Saline implants are inserted without saline, and then filled with saline solution. This can increase the risk of rippling because of the higher viscosity of saline compared to silicone gel. Extreme overfilling or underfilling can cause the implants to scallop/ripple along the edges. Saline implants can also lose volume over time if the valve fails.
- Silicone Implants: Silicone implants, especially those with cohesive gel (often called "gummy bear" implants), are less prone to rippling due to their lower viscosity and ability to maintain their shape.
- Textured Implants: Textured implants are more likely to ripple than their smooth counterparts.
- Round vs. Anatomical Implants: Round implants are generally more prone to rippling than anatomically shaped implants because any slight movement can cause the implant to wrinkle or ripple.
Implant Size and Shape
Choosing an appropriate implant size and shape is crucial to minimize rippling.
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- Oversized Implants: Breast implants that are too large for a woman's anatomy can put excessive tension on the breast skin, increasing the risk of rippling. Larger implants have more surface area, increasing the chance of rippling.
- Inadequate Width: An appropriate implant width is the same or just under the diameter of your breast, and the diameter may need to be on the lower side if you have very little natural tissue to cushion the implant edges.
- Profile: Round implants of the same width may have different degrees of projection. Lower profile implants are flatter, wider, and ultimately add more roundness to your upper pole, and higher profile implants project more in the center of your breasts.
Implant Placement
The placement of the implant significantly affects the likelihood of rippling.
- Subglandular Placement: Implants placed above the muscle (subglandular) are more likely to exhibit rippling because there is less soft tissue coverage to mask the implant's texture. In this plane, especially in thin or small-breasted women, there is minimal coverage for the implants.
- Submuscular Placement: Placing the implant below the muscle (submuscular) provides a transition layer between the breast tissue and the implant, reducing the visibility of rippling. The muscle helps by providing a transition layer between your breast tissue and implants. Most women choose to have their breast implants placed submuscularly, or under the muscle. However, even with this placement, it’s important to note that the muscle doesn’t completely cover the implant. As a result, visible rippling may still occur, especially towards the center of the cleavage or on the side of the breast.
Body Type and Tissue Coverage
Individuals with thinner skin, less breast tissue, or a low body fat percentage are more prone to rippling. If your breasts are naturally very small, you may have poor tissue coverage over your implants, which can result in visible breast implant rippling. Loss of fat in the breast area can thin the tissue covering the implant, making any ripples or wrinkles in the implant more apparent.
Capsular Contracture
Capsular contracture, the formation of a thick, hard scar tissue capsule around the implant, can distort the implant's shape and lead to rippling.
Surgical Technique
The surgeon's technique in creating the implant pocket is critical.
- Pocket Size: The pocket must be appropriately sized to match the implant. A pocket that is too large allows the implant excessive movement, leading to unnatural positioning and rippling. An overly tight pocket can compress the implant, distorting its shape and causing rippling.
- Pocket Conformity: The pocket should closely mirror the shape and dimensions of the implant to stabilize it and reduce the risk of shifting, folding, or rotation, all of which can contribute to rippling.
- Careful Dissection: Once surgery begins, careful dissection of the implant pocket is critical. This ensures that the pocket matches the shape and size of the implant to prevent excessive movement and reduce the chance of folding or rippling. Ensuring the pocket isn’t too large is crucial, as an oversized pocket allows the implant to shift and potentially fold and ripple.
Weight Fluctuations
Weight fluctuations can significantly impact the appearance and integrity of breast implants, including contributing to implant rippling. Significant weight gain or loss can alter the amount of natural breast tissue that overlays the implant. Weight loss after surgery can exacerbate rippling.
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Prevention Strategies
Preventing breast implant rippling involves careful planning and execution by both the patient and the surgeon.
Pre-Surgical Considerations
- Realistic Expectations: Have an honest conversation with your surgeon about your desired outcome and whether it is realistically achievable given your anatomy.
- Surgeon Guidance: Let your surgeon guide you through the implant selection process, understanding their recommendations and the potential risks involved.
- Stable Weight: Maintain a healthy, steady weight before and after surgery to minimize fluctuations in breast tissue.
- Choose a Board Certified Cosmetic Surgeon: Choose a board certified cosmetic surgeon who has extensive experience with breast augmentation and is well-versed in the intricate surgical technique required to get a sound, beautiful-looking result.
Surgical Techniques
- Implant Selection: Choose silicone implants over saline implants when possible, especially if you have limited natural breast tissue.
- Implant Placement: Opt for submuscular implant placement to provide better tissue coverage. However, most surgeons place implants in a partially submuscular position, which can lead to rippling in the lower and outer poles of the breast. Still, this placement will not be ideal for every patient.
- Appropriate Sizing: Select an implant size and shape that is proportional to your body size and existing breast tissue.
- Pocket Creation: Ensure the surgeon meticulously creates an appropriately sized implant pocket that matches the implant's dimensions.
- Fat Grafting: Consider fat grafting to add extra soft tissue coverage over the implant, particularly in visible areas like the cleavage or sides of the breasts.
- Fascial Flaps: Fascial flaps are another surgical technique used in breast augmentation procedures to enhance the coverage and support of breast implants. Fascia is a thin yet sturdy layer of connective tissue. In the context of breast surgery, surgeons may use the fascia from the pectoral muscles to help envelop and secure the breast implant.
Post-Operative Care
- Compression Garments: Wear a surgical bra or compression garment as directed by your surgeon to stabilize the implants and prevent shifting during healing.
- Activity Restrictions: Avoid strenuous activities and heavy lifting for several weeks post-surgery.
- Massage: Follow your surgeon's recommendations regarding massage techniques to promote healing, improve tissue flexibility, and minimize scar tissue formation. The main goal is to promote healing, improve skin and tissue flexibility, and minimize the formation of hard scar tissue, known as capsular contracture, around the implants. It’s crucial to first talk with your surgeon before starting any massage routine, however.
Diagnosing Breast Implant Rippling
Diagnosing implant rippling involves a visual examination and physical assessment by a plastic surgeon.
- Visual Inspection: The surgeon will visually inspect the breasts in various positions (standing, lying down, bending forward) to highlight any surface irregularities.
- Palpation: The surgeon will palpate the breasts to assess the texture and integrity of the implants and surrounding tissue.
Grading of Rippling
Breast implant rippling is graded based on its visibility and impact:
- Grade 1 (Mild): Rippling is not visible in a neutral posture but may be palpable upon close examination. It has minimal cosmetic impact.
- Grade 2 (Moderate): Rippling is occasionally visible in certain positions and may be palpable in the standing position. It may cause some cosmetic concerns.
- Grade 3 (Severe): Rippling is clearly visible in most positions and is easily palpable. It significantly impacts the aesthetic appearance of the breasts.
Treatment Options
If rippling occurs, several treatment options are available, ranging from non-surgical approaches to surgical interventions.
Non-Surgical Options
Non-surgical options are limited and primarily aim to improve the appearance of rippling:
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- Supportive Bras: Wearing supportive or padded bras can help camouflage minor rippling.
- Hydration and Diet: Adequate hydration and a diet rich in vitamins and minerals can improve skin elasticity, potentially reducing the visibility of rippling.
- Skin-Firming Creams: Skin-firming creams and lotions can improve skin texture and firmness, making rippling less noticeable.
- Massage: Massage techniques can help implants settle into place, ensuring proper positioning and alleviating minor rippling by promoting soft tissue flexibility. Compression and zonal massage techniques can both be beneficial.
Surgical Options
Surgical intervention is often necessary for significant rippling (Grade 2 and 3).
- Implant Exchange:
- Changing from saline to silicone implants.
- Using a different size or profile to better suit the patient’s body.
- Implant Repositioning: Moving implants from above the muscle to under the muscle or into a dual-plane position can provide more coverage.
- Pocket Revision: Tightening the pocket that holds the implant can reposition it and make it more stable.
- Capsulectomy: Removing the scar tissue capsule around the implant can reset the environment and reduce tension on the implant surface, particularly in cases of severe capsular contracture.
- Fat Grafting: Injecting fat into the breasts to provide extra padding around the implant can camouflage rippling and enhance the natural look and feel of the breasts.
- Acellular Dermal Matrix (ADM): Using ADM or meshes to create additional soft tissue coverage over the implant, especially in patients with insufficient natural breast tissue.
- Serratus Anterior Fascial Flap: The serratus fascia is a thin layer of tissue overlying the serratus muscle, which has two dominant vascular pedicles. The lateral thoracic artery is a direct branch of the axillary artery that runs along the anterior border of the serratus muscle and the serratus branch of the thoracodorsal artery. The thoracodorsal artery gives off two to four branches just before entering the latissimus dorsi muscle, and the most distal branch is the dominant pedicle of the serratus muscle and fascia. The serratus pedicle gives several side branches as it courses caudally within the fascia. The fascia was then carefully harvested from the serratus anterior muscle and reflected for covering the lateral aspect of the implant as an onlay flap onto the ADM-capsular plane, using absorbable sutures. The fascial flap has good vascular support, not requiring any intake process or incorporating process as for grafts and ADMs. It increases the thickness of the prosthesis overlying skin, in contrast to ADMs, which are thin, and in skinny patients their incorporation can lead to scar adhesion between the implant capsule and the subcutaneous tissue, causing the rippling phenomenon.
Recovery and Costs
- Recovery: It takes months for the swelling to completely abate after breast surgery, and your surgeon will likely prohibit intense physical activity and exercise for six to eight weeks. In most cases, however, patients can return to work, driving, and normal daily activities one to two weeks after surgery. You will experience some bruising and discomfort in the first few days after any breast surgery. Your surgeon will prescribe medication to keep you comfortable during this time, and your pain should decrease a bit every day.
- Costs: The cost of treating rippling can vary widely depending on the surgical approach, location, surgeon's expertise, and complexity of the case. On average, fat grafting starts at about $3,000 while exchanging or repositioning implants can start at $5,000 but can easily exceed $10,000 or more.