Rippling correction

kjyhfrank · 04-21-2009, 10:15 PM

Hi Dr. Revis,

I had my breast augmentation November 2008; had a hematoma & went back to surgery 5 days PO. I have 322 silicone textured overs.

About 3 months ago, I started noticing rippling on the insides of both breasts. It has continuously gotten worse since then. Now the ripples are very evident on the insides & outsides of both breasts.

I saw my PS a month ago & she did view the rippling. I went back to see her last week & she said the best course of action to take at this point would be to place Lifecell ADM inside the pockets on the insides of my breasts. Going back in to put them under the muscle doesn't really guarantee that the rippling won't come back. We wouldn't do anything to the outsides since they are unable to be seen by anyone but me.

Do you have any experience using this or similar brands like Alloderm? And for a situation like mine? I keep reading about Alloderm being used for breast reconstruction, but not for issues like rippling. What is your opinion on this?

Thanks so much.

drdonrevis · 04-22-2009, 01:53 PM

Good afternoon,

I am gaining a good bit of experience with using these products for rippling. However, my approach in your case would be somewhat different.

When a patient with overs and a textured implant comes in for a consultation, I recommend the following:

1) Switch to a completely submuscular pocket. This makes mammograms better, looks and feels more natural, reduces your complication rate (CC rate), and reduces rippling by padding the implants with the muscle tissue

2) Switch to a smooth implant. Textured implants are typically used over the muscle to reduce the riosk of CC. Beneath the muscle has a lower CC rate to begin with, AND the texturing offers no advantage beneath the muscle (beneath the muscle smooth and textured have the same CC rate which is lower than any implant placed inthe over position). Your textured implant has a thicker shell than a smooth implant, making it more obvious and rippling more.

As for the sheets of implantable material, I use them only after #1 and #2 have not totally corrected the problem, and as in your case, it is usually in the midline (cleavage) area.

I do not use it if I have not done steps 1 and 2. Why?
1) These materials are expensive- VERY expensive
2) They are very thin, so after all of the expense they still may not totally take away the rippling
3) They can cause an inflammatory reaction which may result in a seroma (fluid collection) or even a CC

So my recoomendation to patients is keep it as siomple as possible. Each additional variable you introduce into the equation makes the results less predictable.

Hope this helps!

Sincerely,
Don Revis, MD
www.SouthFloridaPlasticSurgery.com

kjyhfrank · 04-23-2009, 10:51 PM

Dr. Revis,

Thank you so much for your detailed response. I am trying to become as educated as I am able before I choose my next step.

My PS will be using complimentary samples of the Lifecell Strattice on me, so there will be no charge for it. She is also not charging me her fees. The two things I will have to pay for are anesthesia & hospital fees.

In light of that, would you say that it is worth going this route? I know you stated that the expense of the material is a major deterrent, which is eliminated in my case. Or would you say the best option would be to start over w/ new smooth implants under the muscle? I am pretty certain that there would be more fees involved (new implants, more surgery time, possible PS fees, etc.) in that situation. However, I definitely want to do the right thing for long-term, not just a quick fix.

Thank you so much for your advice.

drdonrevis · 04-28-2009, 12:38 PM

Good afternoon,

That's good news regarding the Strattice! Being a strong proponent of the submuscular approach, I would still switch to unders with smooth silicone before the Strattice. The Strattice may not work, and it is really just camouflaging the problem not correcting it. You're very early in your breast augmentation experience and this is likely not the end of the "issue" unfortunately. With that said, I do hope that the Strattice works for you and that I am totally wrong!!

Best Wishes,
Don Revis, MD
www.SouthFloridaPlasticSurgery.com

04-28-2009, 12:38 PM	#4
drdonrevis Certified by the ABPS Join Date: Dec 2007 Location: fort lauderdale florida Posts: 411 Thanks: 0 Thanked 190 Times in 147 Posts	Redo Strattice Good afternoon, That's good news regarding the Strattice! Being a strong proponent of the submuscular approach, I would still switch to unders with smooth silicone before the Strattice. The Strattice may not work, and it is really just camouflaging the problem not correcting it. You're very early in your breast augmentation experience and this is likely not the end of the "issue" unfortunately. With that said, I do hope that the Strattice works for you and that I am totally wrong!! Best Wishes, Don Revis, MD www.SouthFloridaPlasticSurgery.com

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04-21-2009, 10:15 PM	#1
kjyhfrank Join Date: Mar 2008 Location: Tennessee Posts: 240 Thanks: 131 Thanked 110 Times in 101 Posts	Rippling correction Hi Dr. Revis, I had my breast augmentation November 2008; had a hematoma & went back to surgery 5 days PO. I have 322 silicone textured overs. About 3 months ago, I started noticing rippling on the insides of both breasts. It has continuously gotten worse since then. Now the ripples are very evident on the insides & outsides of both breasts. I saw my PS a month ago & she did view the rippling. I went back to see her last week & she said the best course of action to take at this point would be to place Lifecell ADM inside the pockets on the insides of my breasts. Going back in to put them under the muscle doesn't really guarantee that the rippling won't come back. We wouldn't do anything to the outsides since they are unable to be seen by anyone but me. Do you have any experience using this or similar brands like Alloderm? And for a situation like mine? I keep reading about Alloderm being used for breast reconstruction, but not for issues like rippling. What is your opinion on this? Thanks so much.

04-22-2009, 01:53 PM	#2
drdonrevis Certified by the ABPS Join Date: Dec 2007 Location: fort lauderdale florida Posts: 411 Thanks: 0 Thanked 190 Times in 147 Posts	Alloderm Strattice NeoForm Good afternoon, I am gaining a good bit of experience with using these products for rippling. However, my approach in your case would be somewhat different. When a patient with overs and a textured implant comes in for a consultation, I recommend the following: 1) Switch to a completely submuscular pocket. This makes mammograms better, looks and feels more natural, reduces your complication rate (CC rate), and reduces rippling by padding the implants with the muscle tissue 2) Switch to a smooth implant. Textured implants are typically used over the muscle to reduce the riosk of CC. Beneath the muscle has a lower CC rate to begin with, AND the texturing offers no advantage beneath the muscle (beneath the muscle smooth and textured have the same CC rate which is lower than any implant placed inthe over position). Your textured implant has a thicker shell than a smooth implant, making it more obvious and rippling more. As for the sheets of implantable material, I use them only after #1 and #2 have not totally corrected the problem, and as in your case, it is usually in the midline (cleavage) area. I do not use it if I have not done steps 1 and 2. Why? 1) These materials are expensive- VERY expensive 2) They are very thin, so after all of the expense they still may not totally take away the rippling 3) They can cause an inflammatory reaction which may result in a seroma (fluid collection) or even a CC So my recoomendation to patients is keep it as siomple as possible. Each additional variable you introduce into the equation makes the results less predictable. Hope this helps! Sincerely, Don Revis, MD www.SouthFloridaPlasticSurgery.com

04-23-2009, 10:51 PM	#3
kjyhfrank Join Date: Mar 2008 Location: Tennessee Posts: 240 Thanks: 131 Thanked 110 Times in 101 Posts	Dr. Revis, Thank you so much for your detailed response. I am trying to become as educated as I am able before I choose my next step. My PS will be using complimentary samples of the Lifecell Strattice on me, so there will be no charge for it. She is also not charging me her fees. The two things I will have to pay for are anesthesia & hospital fees. In light of that, would you say that it is worth going this route? I know you stated that the expense of the material is a major deterrent, which is eliminated in my case. Or would you say the best option would be to start over w/ new smooth implants under the muscle? I am pretty certain that there would be more fees involved (new implants, more surgery time, possible PS fees, etc.) in that situation. However, I definitely want to do the right thing for long-term, not just a quick fix. Thank you so much for your advice.