Visible ripples in implants

Hi Everyone, Happy New Year!  Here's hoping 2011 is a healthy year for all with some answers to our rippling questions.

Kate, Sweetie, Determined, catching up on positngs the last two weeks.  Ditto, ditto, ditto to everything you guys said.  It is just so hard to know the next step.  Here are my questions that have a variety of answers depending on the woman or PS:

Will going larger get rid of ripples?  My PS says no, but a few women on bc.org have had ripples improve with larger implants. For me, I do not want larger implants.

Can a revision which gets rid of some excess skin fix ripples?  This seems so plausible to me, just pull the outside tight over the implant.  My PS says no, the natural tendency of implants to wrinkle would likely recur.

Will fat grafts help ripples, wrinkles? I had one round, helped with step off and a place where I could feel the implant (like a point), didn't do much for ripples.  Would like a second round, PS says it wouldn't do anything for ripples.

What causes ripples? Thin skin, overstretched tissues, the nature of implants which are wrinkled outside the body??????????????

The last thing I want to do is mess up what I have since I think I have an decent outcome.  So as time goes on, I am leaning more toward doing nothing.  I am postponing my final decision until March or after to make sure all is settled.  Since I have been so lucky in terms of healing, I worry what if a revision causes an infection if I opt for another surgery?  I so feel for the women who have had to deal with that. Plus I've had a Lat D and rads, so I feel I have to be even more careful of further elective surgery. 

It's the indecision that bugs me because the answers are so squishy, pun intended. 

Well, overall, I am happy to have new girls to start this new year, even with their "laugh lines"!  HNY to you guys, deekaay.

Hey Deekay-great post!! Good summary of the issues. Right on target. I feel the same way, like my result and afraid to mess with it. I have been wearing bras in 36-C and notice they are sort of wide in the middle so I put a few stitches in there and it pulled everything in and my implants looked really good. It gave me back the upper pole fullness and some cleavage. So the thing is they can look very good in clothes and that is not the issue at all, but do I risk that to try to get them to look better out of clothes. I'm with you, not jumping into anything but seriously contemplating what to do. I just "need to know" if it will work or not. Once it's settled in my mind and find out either way I think then I'll know what the right thing to do is. To me it sounds like your getting to that point and making peace with things. That's a good thing and you know it's not like we can't have a revision at any time down the road if we decide too. You have a great attitude about this!

Happy New Year to all!

Kate33 -

That's what I had done.  I had 500cc implants and although I didn't have much rippling, I had other issues that brought me to Dr. Khouri.  He replaced them with 300cc implants and did two rounds of fat grafting.  I love the results!  At the first session where he replaced the implant, he had to do quite a bit of work on the pocket and other things but ended up putting in 300cc of fat on each side.  Since he injects the fat all around the breast, even though it was more volume than the initial implants, I didn't look bigger-just more natural.  The second session was Dec 16th, where he improved the folds under both breasts and injected another 200 cc.  I was nervous and worried like most of you, that I might mess up what I have, especially since I was already pleased with what he had done.  I needn't have worried!  He is truely amazing and did a fantastic job.  They look and feel soft and smooth, and unlike implants they gently slope towards the breast mound.  I've since seen the original surgeon (who performed the MX) and my oncologist who were both amazed and impressed.  So much so that the surgeon asked if I'd be willing to speak to other women who are about to imbark on this journey so they can see that good results are possible. In case you are wondering, I did not wear the BRAVA device.  Only for a 4-5 day period before the first surgery to pull out a dent that I had on one breast.

I know it's tough to decide what to do, but for my part, I'm so glad I did this!  Now for a 2011 with NO, ZERO, NADA surgeries!  :-)

Lee

I've done a little reading about Dr. Khouri's method and it is intriguing.  I would venture a guess that some iteration of this method will probably become the standard down the road.  For me, I wouldn't do it at this point since I have the Lat D and radiated skin.  My skin is doing so well I just wouldn't take the risk.

I would like more fat grafting.  Not sure if I can talk my PS into it and whether insurance would pay.  He said they would not.  I wonder how much it costs out of pocket?  From stuff I've read, even fat grafting is still considered experimental.  Maybe that is the issue with insurance covereage?

Sweetie2040 and deekaay - everything was covered by my insurance.  I'm pretty sure anything that has to do with reconstruction and achieving symmetry must be covered.  Here's what I found on this:

Insurance companies are mandated by federal law to pay for breast reconstruction. Procedures covered include DIEP flap, SIEA flap, GAP flap, TUG flap, TRAM flap and breast implant reconstruction in all breast cancer patients who have had mastectomies (if the mastectomy is covered). Insurance companies must also cover surgery on the opposite breast to achieve reasonable breast symmetry. 

Dr. K's office checked to make sure my insurance company covered my procedures beforehand.

I'm sure with time, more and more surgeons will offer this reconstruction option.  Dr. Khouri has workshops pretty much every month where he trains surgeons from all over the world on this technique.  I'm so lucky that I'm just a little over 4 hours away and was able to go to Miami.

Determined - I'm so sorry that your previous PS made such a mess of your nipples.  Have you seen anyone else (aside from your current PS who says the skin is too tight) to see if anything else can be done?  

Determined, really sorry about your situation.  I wish I had some words of wisdom for you.  It does seem like a second opinion might be in order.  Hang in there, you will find someone who can get you a good result.

leeinfl, I presumed all along that my insurance covered fat grafts since my PS offered fat grafting at the time of my exchange and also when he did nips/areolas. I only opted for one round at nips surgery.  Then at post op, I told PS I might want more fat grafting to fix ripples and that's when he told me insurance doesn't cover it.  He said he just goes ahead and does it when he's doing other covered surgeries if the patient wants it.  My PS does a lot of fat grafting at a major cancer center in FL.  He went on to say that as soon as insurance co sees the lipo as part of the procedure, they won't pay.  So...what do I to make of this?  I know I read elsewhere that fat grafting is still considered experimental at least to some extent.  So I am really wondering if insurance actually does pay.  I guess I could try to call mine, but I hate dealing with them on the phone--I don't know if I could actually talk to someone with enough of a clue to get an accurate answer.

Kate,

There is a bit of rippling not really bad but it does seem to change depending on the day. The shape is very good. I just don't see how they will do the nipples.  I am concerned since I had perfusion problems before which caused the loss of my nipples. Or was it the infection?  Who knows........  I am thinking about getting the nipple from my PS who I really like and having a 3D tatoo artist due the tatooing. Then maybe in the areola that is higher they can lighten part of it so it looks like skin and use the tatoo to move it down so it will be even. Does that make sense? 

Anyone know a medical 3D tatoo artist in the Chicago area?

My PS is just not sold on Dr. Khouri at all, not sure why.

Determined- There is a member on here called Facecrafter (Judy) who is a tattoo artist and she keeps a list of others in the US and Canada.  You could try PM'ing her to see if she has anyone in your area she recommends.

leeinfl- Thanks for the additional information.  I was on Dr. Khouri's site but I guessed I missed the FAQ's.   

Hello my ripple sisters-wanted to give you an update on my PS apt.  My options are a revision to a larger implant 50-100cc's more and some lateral stitching because I have issues when laying down the implants spread to far apart. He said that things will either get a little better or a lot better and I may see "some" resolution for the rippling and the other issue but there is no guarantee. He said I will probably still have "some" rippling. I was concerned about messing with the good result I have so far but he said not to worry that it would definitely look better, but how much better he can not say. No additional alloderm and no fat grafting for this type of rippling. He does do the fat grafting for indents and hollow areas though. He did say I will definitely be a bit larger though because of the larger implant so I really need to think it through because I didn't want to go too much larger.

sweetie- I know what a hard decision this must be for you.  It's hard to weigh everything when you don't really know the ultimate outcome.  I think my rippling may be getting worse, too.  I realize now that the only time I look at myself is a few seconds before or after my shower.  I'm pretty much covered up 24/7.  I feel like this self-consciousness has changed the dynamics with my DH so much that I do think if I was happier with my results it would be worth the risks.  I just wish a larger implant wasn't needed as I already feel too big as it is.

Determined-I agree and I'm really afraid to mess with what I have but he assured me it can only look better, but how much better he can not say. When I said this type of rippling I meant the severe rippling I have every where. He can not inject fat into the all those areas of the breast. He does it for hollow areas on the top only. I have smooth HP style 20. If these ripple there is not much else out there to try except for gummy bear implants (tear dropped) shape. They are textured and will adhere to your skin, but they may still show rippling. I asked him about this as he does these too and he said I would still have rippling with those, plus the shape is really different and  I would lose all the upper pole fullness I have now.

Kate-I feel for you. I feel the same too. I feel great in a bra. In fact I have got it so the bra really pushes them up and they look full, but when it comes off and gravity takes over the ripples start to show up and it's all along the top. I think they have gotten worse too. He said they can get a little worse still but after 4 months shouldn't change much more. To add to all of this mine look odd when laying down (I wonder how everyone elses look?) so I'm really self conscience naked. Also any slight movement involving the pec muscles puts them into an awkward distortion. I really don't want to go larger either. I don't think 50cc's is too much but a 100 would definitely change how I look. I need to think long and hard about this, but if I do it then I'll be the Ginnie pig for all of you to see if it helps or not. I know Vanderlady went bigger but I haven't heard from her since. I was hoping she'd let us know how things are going.

Determined-you really do have a good result, and I don't think your rippling is as nearly as bad as mine. In fact if I do the surgery I may end up getting only a little bit better. However if you look at it that way and you do the surgery your's may resolve almost completely. I do agree you have a good shape and size right now. What should be all do???

oh forget to mention I saw my friend who just had her surgery in Dec and she has a very nice result but when she bends over she has rippling on the side, but not when she is standing straight up. I can deal with that and realize there will always be some rippling,but I would at least like to to not see it when standing striaght on.

Newsflash--I am getting another round of fat grafting in April!!  Was planning to wait until March to make some decisions about next steps, But had to see PS about some muscle pain (I hoped) that had to do with Lat D surgery (all ok in this regard).

So, this time after talking w/ his resident who came in first about my ripples, she expresses concern and says he sould be able to address with fat grafts.  He comes in and agrees to go ahead and do them  No begging necessary.  He then made a big deal about being sure I was aware that the FG can cause rice or pea lumps to appear that can be unnerving and require investigation.  You just have to live with that if it occurs.  

I asked him if pulling the lower skin tight at the bottom would rid the ripples and he said no.  When I do that now, they disapper. I didn't ask about larger implants because I just don't want to go an larger. I'm sure of that.  So I am feeling pretty good about this.  Recovery time is short, sore for a while from lipo, but no biggy.  deekaay

I found this article online for a PS office in Phoenix about fat grafting.  It says that is was reprinted, with permission from the American Society of Plastic Surgeons, and the last part specifically says fat grafting works for rippling.

Thanks, Kate, I'll be sure to post my experience when I get round two of fat grafting.

Sweetie, exactly.  I should have been totally done with the tatooing and everything last June. But I guess I am very thankful with all the complications I kept the TE's and the implants went in without complications. I change my mind every other day.  He won't do fat injections so my choices are a bigger implant by 5occ's and additional alloderm or just more alloderm maybe.

 My husband will not give me his opinion as he said it really needs to be my decision which it does.

Deekay happy for you!

Sweetie what about textured implants. I have those and they are not gummy bears. Mentor textured high profile.

Gosh I wish we could all meet for coffee and talk in person