Answers
"I had breast augmentation two years ago. The implants are saline and after a year they started to ripple and bottom out. I have had two consultations with two different opinions on how to correct this problem. One was to make incisions at the bottom of the implants to lift them up. Is this the way to go or should I consider replacing them with silicone implants?"
— Answered by
V. Leroy Young, MD
St. Louis , MO
This is a two part question. One issue is rippling. The primary cause of rippling is inadequate tissue padding which allows the folds which normally occur in the implant shell to be transmitted to the skin. There are other factors that contribute to rippling including subglandular position, saline-filled implants, and textured implants. The lowest incidence of rippling is seen with smooth silicone gel implants in the submuscular position. However, rippling can occur in thin individuals with any implant.
Inferior migration of implants also has several causes including implants that are too large for the patient. There is no definition of what is too large but the base diameter of the implant should not exceed the base diameter of the breast. Thin women with long chests seem to be at greatest risk. Assuming the implants aren't too large, most surgeons would recommend starting with a capsuloraphy. A capsuloraphy involves making an incision around the aerola or in the breast and closing off the bottom of the breast implant pocket with sutures. This raises the implant to where the center of the implant is beneath the nipple. If this does not hold up over time, switching the implant to a different position can be an option, however most saline implants are in the submuscular position to minimize rippling and switching to a subglandular position will almost certainly make the rippling worse. Under these circumstances, a fascial flap using the anterior fascia of the rectus abdominous muscle can produce a lasting correction in many cases. Some individuals produce very thin capsules and are prone to implant migration. Therefore a lasting correction of implant migration can be a difficult and recurring problem.
