Saline Implants and Rippling
One of the major complaints of patients with saline implants is visibility or rippling of the implant edge. All implants, saline and/or silicone, can create rippling both along the medial as well as the lateral breast. Rippling is associated with an underfilled round object. Rippling is furthermore increased the flatter the object gets. For example, the low profile saline implants ripple significantly more in women with thinner breasts than the high profile salines which are rounder implants. In the law of physics, the rounder an object becomes, the less scalloping or visibility of the edges appear. As a result, I prefer not to use low profile or moderate plus profile saline implants whenever possible and prefer high profile saline implants. Rippling can occur with saline implants in patients who are ectomorphic build with minimal amounts of breast tissue, especially when implants are placed subglandular or retromammary. As a result, we place the implant using the dual plane technique two-thirds under and one-third over laterally. As much muscle coverage as you can obtain, the less visibility and rippling you will have with the saline implants. Patients of ours who have come back, having lost significant amounts of weight or who have had pregnancies and then lost the baby fat may also present with severe visibility and rippling along the medial and/or lateral breast. It is a distressing feeling seeing the bag edge, especially along the inner breast where the cleavage forms.
Antidotes for severe rippling include increasing saline implant fill, changing the bag to a more high profile implant or possibly changing to an extra high profile style 45 silicone gel implant. It should be noted that even silicone implants do ripple and silicone implants are not always the answer for visibility or rippling of saline implants. In fact, I have found that the patients who ripple even with style 45 gels, increasing fill on a style 68 high profile saline Allergan implant by 20% of its low range volume, will greatly reduce visibility of the bag. Other reconstructive methods include acellular dermal matrices (ADM), placing this stratus or AlloDerm-like material into the breast and placing the implant in the new submuscular plane in order to reduce visibility and enhance tissue coverage.
Stuart A. Linder, M.D., F.A.C.S. is a Beverly Hills plastic and reconstructive surgeon specializing in breast augmentation, liposuction, tummy tuck, and more.
Dr. Linder is certified by the American Society of Plastic and Reconstructive Surgeons and is a diplomate of the American Board of Plastic Surgery.
READ ARTICLE
Skin Deep Magazine
"Reasons For Reoperation:
Breast Revision Surgery"
Contributing Writer:
Dr. Stuart A. Linder,
Board Certified Plastic Surgeon
January 2006
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