Texture Problems: Rippling, Wrinkling or Palpable Implants

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Rippling & Wrinkling

Rippling occurs when there is not enough tissue coverage over the implant and leads to a wavy appearance usually when a woman leans over. This can happen medially (towards the middle), superiorly (on top), or laterally (towards the sides).  Rippling happens more frequently with saline implants than silicone and more frequently with textured implants than with smooth implants. The worst rippling is seen with subglandular textured saline implants.

Determining the cause of rippling is important to correction. Subglandular rippling is usually seen superiorly or medially and is corrected by submuscular conversion in which the implant is removed from the subglandular position, a portion of the capsule is removed, a new pocket is created under the muscle and the implant is replaced under the muscle.

Most women will opt for new implants and smooth silicone or saline are chosen.  Submuscular rippling due to textured implants is corrected by changing to smooth silicone or saline implants. Submuscular rippling with smooth saline implants is corrected with a change to silicone. The more difficult problem is rippling with a smooth silicone implant present. Correction involves reinforcing the thin breast area with either capsule, muscle or Strattice (acellular pig dermis). Surgical times for simple exchange are quick and recovery easy while more difficult problems and submuscular conversion lead to longer operative times and recovery similar to primary augmentation.

            Rippling with subglandular implants. Corrected with submuscular conversion.

Palpable Implants

Most women can feel the edge of the implants under the breast and laterally. This is where the skin is thinnest. Sometimes changing to a smooth silicone implant will correct this. The more difficult problem is a palpable or visible knuckle of implant poking through the skin. Ocassionally this may happen after trauma such as a motor vehicle accident from a seatbelt of airbag. If subglandular, then submuscular conversion may correct this. Submuscular palpability especially if medially may be due to excessive muscle release or muscle tearing. Enhancing the coverage either through muscle advancement or Strattice placement may be necessary.