Breast implant ripples and wrinkling: How to reduce the risk

There are two things that really matter when it comes to breat implant wrinkling, or implant ripples: the consistency of the soft tissue cover and the implant material itself. I know that the issue of implants and visible rippling or wrinkling comes up in implant forums and I often hear it mentioned during consults. In this video presentation I show both saline and silicone implants so you can see how the wrinkling can appear directly on the implant itself as it’s held up. While silicone is more gel-like, it is not immune to wrinkling. I also discuss the gummy bear implant, which has a very stiff silicone consistency, which is recommended for patients with breast reconstruction who have very little soft tissue cover in place.

The soft tissue cover I’m referring to is the skin, fat, and muscle covering your chest wall. The thicker the skin and fat, the less visible wrinkles. Placing the implant under the muscle also helps lessen any visible wrinkles. The illustration of the chest wall helps me explain exactly what it means to have an implant placed “under the muscle” – where the incision is made and how the implant is slid partially underneath the muscle (or muscles). Using a simple mock-up drawing of an implant, I show you how thin skin tends to look with implant wrinkling, how thicker skin tends to look with implant wrinkling, and how muscle tends to look with implant wrinkling.

In general, when I do breast augmentations I’d rather place the implant under the muscle, with the technique I describe at length in the video, creating a muscle sling underneath that will tend to hold the implant and, at the same time, cover up any wrinkles. You can learn even more about what causes implant wrinkling and how to reduce risk and you can see our patients’ before and after augmentation photos to see examples of the results achieved with my breast aug techniques.

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Hi, I’m Dr. Ricardo Rodriguez and today I want to talk to you about the issue of implants and wrinkling.

I get on the implant forums quite a bit, and I do hear from some of my consults, that people are concerned about the issue of breast implants and wrinkling.

Now, there are some types of implants which do tend to cause – or actually have a little bit more visible – wrinkling, and those are the saline implants.

And you can see here, just holding the implant up, you can see those wrinkles on the surface – and that’s pretty much how the implant behaves when it’s stuck on your chest wall, there will be some wrinkling visible. Does it show on every patient? No.

Now, we take the more gel-like silicone, and you see that it still also wrinkles. So, gel implants are not immune to wrinkle. And, as a matter of fact, I have one patient who’s very skinny, with a very thin tissue cover, whose implant wrinkles and it’s visible. Does every patient with silicone have visible wrinkling? No.

Now, there’s another type of implant that has even less wrinkling – as a matter of fact, it’s recommended for patients with breast reconstruction who have very little soft tissue cover – and that’s a gummy bear implant. It’s a stiffer kind of a silicone and this is, for example, a buttocks implant, not a gummy bear implant, but you know, the thickness and consistency is similar in that it’s very stiff and it doesn’t wrinkle; but, you know, you pay a price – the implant does feel harder, it doesn’t feel like a nice, soft breast.

The two things that really matter, then, are the consistency of the soft tissue cover and the material itself.

Now, for example, if you have thicker skin, and fat, you will tend to see wrinkling a little bit less. And muscle is also are very important, because muscles have tone, and muscle is active and it forms a kind of barrier to the wrinkling so that, even though the implant might be wrinkling underneath, if the muscle itself has some tone, you won’t necessarily see them wrinkling.

Now, let’s take an illustration of the chest wall here. What do people mean when they say that the implant is under the muscle? Well, you know, it’s not really totally under the muscle, because the muscles are stuck to the chest cage, so it’s impossible to fit an implant totally underneath the muscle.

So what we do is, we make an incision over here on the PEC major muscle, to slip the implant underneath it. Now, in the routine case, that implant is only really partially (under) the muscle. In other words, it’s covered on the top by the muscle, but below is not covered by muscle, it’s just skin and whatever fatty tissues you have underneath it.

Now, let’s take this mock-up of an implant in here. So here’s an implant that’s not wrinkled or anything with its shell. But let’s say here it wrinkles, okay? Now, if your skin and fat is thin, more or less like in this line here, and you see the wrinkle, well, the skin is pretty much going to follow the wrinkle, and and it’s going to be very visible.

If you have a thicker skin and fat coverage, well it’s not going to show the wrinkle as much. And, of course, the more fat and breast tissue you have, the less amount of wrinkling you’re going to be able to see; but, you know, you could still see it.

So if you had a choice, you would rather use a silicone implant because it’s not going to be seen as easily, but you’re not totally immune to it.

Now, if you’re covering with muscle, the muscle has tone. It’s active independently of what the implant is doing. So although you may have a very thin skin and fat tissue cover, if you have a good muscle cover, it’ll tend to camouflage the wrinkling very well. For this reason, I have modified the way I do my “under the muscle” implants.

Now, let’s take, for example, here’s the case of the implant that’s partially under the muscle, but then exposed in here. What happens is, the area that’s under the muscle is well covered, so these implants usually don’t show much wrinkling above – which is okay because most people, when they’re dressed, that’s the area that’s uncovered, so they’re going to have their implants not showing a wrinkling. However; on the side, where there is very thin tissue coverage, you may see wrinkling. Now, on the other hand, if the patient has a little bit more fat and subcutaneous tissue, you may not see the wrinkling as much.

Let’s take the case of an implant that’s under the muscle. In here, I drew a wedge of where I slip the implant underneath the serratus muscles, which are here, and the external oblique muscles and under the pectoralis major muscle.

So this implant is not totally under the muscle, but it’s mostly under the muscle. So this is the only area that’s exposed, but you know, most of the breast mass is in here, and the nipple and areolar complex are here.

Now, what happens here is that all the areas that might wrinkle are covered by muscle; and, since the muscle has tone, it will tend to camouflage it very well. So, I feel that this technique is much better at camouflaging wrinkles than the other, so-called, soft muscular technique.

This technique, you know, like everything, it has its pros and cons. It does tend to be a little bit more painful because you elevate more muscle and that, in a sense, is why I’m such a proponent of pain pumps. The pain pump takes care of the the so-called con of this procedure, which is the pain. The advantage, of course, is that you have a much better soft tissue cover for the implant.

If you have any questions that you feel I don’t have covered in this little presentation, just write a question underneath the blog post and I’ll answer it. But, in general, when I do my breast augmentations, I’d rather place my implant under the muscle, with this technique, creating a muscle sling underneath that will tend to hold the implant and, at the same time, cover up the wrinkles.

Anyways, thank you very much for having listened to me and having been so patient and keep the questions coming, I will answer them. And have a great day! See you.

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