Explore Plastic Surgery - Dr. Barry Eppley

Saline-filled breast implants typically have some amount of rippling or wrinkling which is not usually seen with silicone gel breast implants. (although it can still occur) This is particularly evident in women with thin skin and very little breast tissue. Implant wrinkling is felt on the bottom and sides of the breasts and can be seen as patterned set of lines visible through the breast skin. Breast implant wrinkling is usually most visible in certain positions, particularly when one is leaning forward or lying on your back. Wrinkles on a saline breast implant may be only a minor cosmetic issue (if you were informed before surgery) or might be a source of major unhappiness and be the reason to undergo revision surgery.

 
Rippling occurs as a result of the physical interface between the saline and the elastic silicone polymer shell . The exact reason wrinkling of the breast implant occurs has to do with how well the filler material coats the inside of the implant and bonds to it as well as its own viscosity. Water (or saltwater) flows easily and does not ’stick’ well to the inside wall of the breast implant shell, resulting in implant buckling and folding. This is a normal finding with saline breast implants and its presence is not abnormal or the plastic surgeon’s fault. Placement of saline breast implants above the muscle is also much more likely to lead to visible implant wrinkling in thin individuals as there is little breast tissue to cover the visible ripples and there is no pressure on the implant from the overlying muscle. Textured saline implants are particularly prone to rippling due to their thicker shell (harder for the water to push it out) and due to traction from the implant grabbing the thicker non-stretchable surrounding scar that it creates. The combination of textured saline breast implants above the muscle has the highest incidence of significant wrinkling issues.

 
Established ways to diminish the amount of wrinkling which can occur are to overfill the breast implant with more saline than the implant base size (increase the internal fluid pressure) and to place the saline breast implants under the muscle. (which puts more pressure on the outside of the implant). Both of these methods do lead to less wrinkling, but neither can completely prevent it. Overfilling a breast implant with too much saline will make it feel more firm than normal breast tissue, although this is generally well accepted by most patients. The best approach for prevention is to use non-textured saline implants placed under the muscle which are then filled 25 to 50cc more than its base size. While all implant wrinkling can not be prevented with saline fills, a significant reduction can be seen in most patients with this approach.

 
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

There are two good reasons why patients choose silicone gel breast implants over saline…and one of those is that silicone breast implants have significantly less rippling or wrinkling than saline. This is of great aesthetic importance to those women with very little breast tissue and thin or stretched out skin where the outline of the breast implant can clearly be felt and often even seen. This is most evident in the inferior (lower) and lateral (side) poles of the breast implant where the chest muscle does not provide coverage.

 
The phenomenon of breast implant rippling is actually present in both saline and silicone filled implants. The exact reason wrinkling of the breast implant occurs has to do with how well the filler material coats the inside of the implant and bonds to it as well as its own viscosity. Water (or saltwater) flows easily and does not ’stick’ well to the inside wall of the breast implant shell, resulting in implant buckling and folding. This is a normal finding with saline breast implants and its presence is not abnormal or the plastic surgeon’s fault. This is why we usually overfill the saline breast implant to generate increased pressure on the inside which lessens the amount of wrinkling that can occur. In the short-term this works but, over time, the plastic bag of the implant stretches a little and relaxes, creating some rebound wrinkling if you will. Silicone gel, a much thicker (viscous) material and with slightly more weight, coats the inside of the implant shell better and is more effective at lessening wrinkling.

 
The point is….silicone gel breast implants have less wrinkling, usually substantially less, but it may not always be zero. I have had several women who have small amounts of rippling in the lateral (side) pole of the breast. Usually it is only one or two small ripples, which would be less than that which would have been present had they been saline implants instead. I can’t say at this point whether this subtle rippling phenomenon in silicone implants is less evident in high profile (projection) versus medium or low profile style implants. I think it is more reflective of the lack of breast tissue between the overlying skin and the breast implant, an anatomic issue in which no type of breast implant can completely overcome.

 
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis