Expert: Gurmander Singh Kohli, MD, FACS - 11/24/2007

Question
QUESTION: I had breast augmentation exactly a month ago and am now experiencing rippling on the sides of my breasts.  I have Mentor smooth, round, moderate profile, saline implants.  My breast implant size is 375 cc, and the final fill volume was 420 cc. They were placed beneath the muscle also.  I am wondering if this is a temporary phenomenon that often occurs, or if it will be permanent. It is more palpable than noticeable by sight, but it bothers me.  My breasts have softened up considerable and I don't feel like I'm having capsular contracture.  If the rippling does not go away, are there any other options to correct this other than getting silicone implants? In addition, is revision of this type of problem usually as costly as the initial breast augmentation?  
Thank you!
Pam

ANSWER: On the sides as there is no muscle issue or not much breast tissue to cover the implants, it is not  unusual to feel or see rippling. This can happen with either Mentor or McGhan (Inamed, Allergan or Natrelle) manufactured implants. Silicone implants are usually associated with considerably less rippling if any. If you see rippling, then of course it is much worse than if you can just fee it. Depending on how thin your tissues are in the areas where you are seeing the rippling one may need to consider doing more. Adding a layer of Alloderm ( human skin from which all cell have been removed by a special process and it has been made non reactive) most likely will help reduce the rippling. I do not know how much you paid for the initial surgery, the cost of revisional surgery will very likely be more as it will have to take into consideration the cost of the silicone gel implants and the cost of the Alloderm and the surgeon's fees.
I would recommned taking the advice of your original surgeon also on this issue. If I can be of any further assistance please let  me know.
Gurmander Singh Kohli, MD
Associate Professor
Plastic Surgery
Loma Linda University.

---------- FOLLOW-UP ----------

QUESTION: Thank you, Dr.
    I have read about the Alloderm and have two additional questions: Is is a very extensive surgery to have Alloderm placed on saline implants?  I really don't want to change to silicone implants & was hoping the Alloderm would be a viable option for me.  Also:  How long does it generally take to see the final results of BA?  I've heard that what I'm going through is normal but would like a little reassurance!  I do have an appointment with my surgeon in about a week & will definitely ask more questions this time.
Sincerely,
Pam

Answer
Surgery involving the use of Alloderm is not extensive but Alloderm, the material itself is expensive. At give it at least three months to let everything to settle down. So long as the rippling is not visible it may not be bothersome enough to warrant any further surgery. You are going through what is considered the normal course of events. Please give it time and when you see your plastic surgeon again you may ask more questions  but it will be too early to reoperate. Your surgeon has your best interest at heart and as you progress through the healing phases the various options may come into discussion.  Please do not worry as it appears that you are doing well. Keep closely in touch with your surgeon.
Gurmander Singh Kohli, MD
Associate Professor
Plastic Surgery
Loma Linda University,
California