Dr. Stuart Linder is a surgeon in breast augmentation and breast revision surgery. His practice includes a significant proportion of breast revision surgeries on a weekly basis. Patients fly in from all over the United States and some from other continents in order to have their breasts fixed. It’s obvious that the more experience a plastic surgeon has in a specific procedure, hopefully, the better they are going to be with respect and technique. Normally, this goes hand-in-hand.
Visibility of the implant edge, often referred to as rippling of the bag, can be a distressing problem with many patients. Rippling of the implant is simply the visualization of the edge of the bag where there is a scalloping associated with the saline implants. Rippling can also be associated with silicone gel implants as well, although this is less common. When patients undergo primary augmentation mammoplasty, we prefer to place the implants in the dual plane technique with as much submuscular coverage as possible in order to reduce visibility and rippling of the bag, especially along the midline, external area, the cleavage area. However, implants that are placed in the dual plane technique still may have rippling along the lateral breast or the outside portion of the breast due to lack of muscle coverage in that area. Rippling can be accentuated by having the patient lean forward which at times in a bikini, for example, the implants will be more visualized and certainly more palpable.
Saline implants in general ripple more than silicone. Textured implants ripple more than smooth implants. The reason for this is that textured implants will stick to the tissue like Velcro adhesion and the scalloping will then become more adherent to the underlying tissue and the visibility becomes way more noticeable. As a result, I prefer not to use textured implants during my augmentation mammoplasty surgeries in Beverly Hills or Las Vegas. Because women in Las Vegas make a living often associated with their beauty and their breasts, specifically in the casinos, bars and clubs, it is absolutely imperative that we reduce rippling to as minimal as possible. Therefore, once again, smooth implants are usually used by Dr. Linder and not textured.
When a patient comes in for a primary augmentation mammoplasty, in other words, never had breast implants, their body and anatomy is very important in the determination of whether we use saline or silicone gel implants. If a woman has an ectomorphic build and is very thin and has minimal breast tissue and there is a significant visualization of the ribcage and costochondral junction, the sternum and the lateral ribs, then saline implants may not be a good bet. With respect to ectomorphic or thin build women, saline implants will ripple in almost all patients due to the lack of coverage, especially laterally. As a result, with thin women we normally will often consider silicone gel high profile implants to reduce rippling. High profile implants in general ripple less than moderate or moderate plus implants. This is associated with the physics of the implant itself. The rounder a shape or implant becomes, the less scalloping that will occur along the edges. Therefore, high profile implants have less rippling in general than moderate profile. Once again, if you’re very thin, you have minimal breast tissue, you may very much want to consider cohesive high profile smooth silicone gel implants from Mentor or Allergan Pharmaceuticals. Both are excellent implants and are both FDA approved.
Women who have an endomorphic or thick barrel chest would actually do well with saline rather than silicone and will get more fullness with upper pole, which can be lacking with silicone gel. If the patient is thick chested or barrel chested as in some of the Latin-American woman and the women from mid Mexico or central Mexico, they do well with saline and the rippling is not noticed because there is a significant amount of glandular tissue that it is thick along the lateral breast and the muscle is quite thick as well. I prefer saline high profile implants in these patients.
Women who come from secondary or revision surgery often will remove the saline and replace them with silicone cohesive gel implants. Women who present with rippling in their primary surgery will usually undergo silicone gel implants to reduce that visibility and palpability of their bags.
Stuart Linder, M.D., F.A.C.S. is a Beverly Hills and Las Vegas Breast Revision Surgeon who enjoys performing breast augmentations, breast revisions, breast lifts, breast reductions and breast reconstructive surgery. He is a Diplomate of the American Board of Plastic Surgery and a Fellow of the American College of Surgeons and a Member of the American Society of Plastic Surgeons.
Stuart A. Linder, M.D., F.A.C.S. Las Vegas Breast Revision Specialist
9167 W Flamingo Rd, Suite # 110, Las Vegas, NV 89147
Phone: (702) 434-7205