Richard A. Baxter, M.D.

The Art Behind Plastic Surgery

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Jan 02

Dr. Baxter

Solutions for breast implant rippling

Posted by Dr. Baxter

We do a lot of revision breast surgery here, and breast implant rippling is a common concern of patients seeking revision. There are two factors that contribute to this: thin tissue coverage and the characteristics of the implants. Correction depends on addressing these issues, either by improving coverage and support or using implants that ripple less, or both. Each involves trade-offs.

Breast implants are most commonly placed under the pectoralis muscle for coverage and more natural contours. It’s important to understand however that the muscle covers only the upper and inner parts of the implant, not the bottom or side. That is why ripples are typically seen or felt on the sides and bottom. Over time, the tissue in these areas may thin out from the weight or pressure of the implants, making the problem apparent even if it was not an issue early on. Larger implants or implants too wide make it worse. Ripples showing on the upper part of the breast – called “traction ripples – most often occur with implants in front of the muscle.

Option 1: Increase implant coverage with ADM or fat grafting

There are two options to increase coverage of breast implants: ADM/mesh or fat grafting. ADM, or Acellular Dermal Matrix, is a material that transforms into durable living tissue over time. The most commonly used ones are Strattice and Alloderm. Strattice is most often the choice for revisions, and Alloderm for primary reconstructive breast surgery. A major advantage of these materials is that they add thickness to the tissue layer, with predictable concealment of implant ripples. Major disadvantages are cost and surgery recovery time. Galaflex mesh is another option in this category. Traction ripples can also be improved by adding support from below in addition to adding coverage over the upper part of the implant.

Fat grafting is increasingly used but less predictable. I find this more useful for minor contour issues but less helpful for significant implant rippling. The challenge is that the fat is placed into an already thin layer, which limits the amount that can reliably survive.

Option 2: Use implants that ripple less

Some types of implants are less prone to rippling. The trade-off here is that it requires the gel in the implant to be firmer, which may feel less natural. We now have choices, from soft to very firm (cohesive.) In between is Allergan’s Soft Touch implant which can be a good choice in thin patients.


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