The top photos show the patient, who underwent several prior surgeries on her breasts, when she first came to Dr. Ennis at Destin Plastic Surgery. He performed an endoscopic implant exchange through the underarm to move her subglandular implants to the submuscular position. Note the significant improvement in the appearance and shape of the breasts when the implants are in the submuscular position (bottom row). The large ripple at the top of the right breast has also resolved.
Rippling & Wrinkling
"Rippling" occurs when the implant shell is easily felt beneath the skin. This condition occurs when the type of breast implant or its placement is not appropriate for the woman's anatomy.
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Rippling Due to Implant Placement
When the breast implants are placed above the pectoral muscle (subglandular augmentation), the possibility of implant rippling is greater than when the implants are placed below the muscle (submuscular position). Large studies have shown that the chance of rippling is 3 times greater with subglandular augmentation than with submuscular augmentation.
The disadvantage of the submuscular placement versus subglandular placement is that the postoperative recovery is usually longer and can be more painful. In addition, there may be more motion of the implant with forceful pectoral contracture. All things considered, the submuscular placement of an implant is the least likely to cause rippling.
Rippling Due to Implant Type
Silicone implants offer a much more natural feel than saline implants and allow women with small breasts to have larger enhancements without rippling. The larger the saline implant and the less breast tissue a woman has, the more likely it is to ripple. Silicone offers small breasted women the option of going much larger with less concern about rippling. Replacing saline breast implants with silicone is a common reason for revision surgery.
This patient had very little breast tissue and underwent a submuscular breast augmentation with saline implants by an outside surgeon (photo on left). She was unhappy with the rippling that occurred when she leaned forward. The patient subsequently underwent an implant exchange from saline to silicone at Destin Plastic Surgery and, as you can see in the right-hand photo, the rippling was significantly improved.