Correction of Rippling in Implant-based Breast Reconstruction with Serratus Fascia Flap

Abstract

Summary: Implant-based breast reconstruction represents the most popular procedure for the treatment of women undergoing skin-sparing mastectomy. In selected patients, it allows for obtaining an excellent appearance of the reconstructed breast with great satisfaction to the patient. However, aesthetic and functional results can be affected by complications requiring reoperation. Among them, rippling is an undesired occurrence associated with implant-based reconstruction. It consists of a cutaneous manifestation, visible and/or palpable, of the implant wrinkles and edge which appear mostly when the patient leans forward. To treat this contour deformity, several techniques have been described such as acellular dermal matrices and autologous tissues. In this study, we intend to add the serratus anterior fascial flap within the autologous options in the treatment of implant rippling, reporting our experience.

The Impact of Breast Implant Cohesivity on Rippling and Revision Procedures in 2-Stage Prepectoral Breast Reconstruction

“…Rippling is defined as either a visible or palpable cutaneous manifestation of a breast implant, in which the contour is evident through the skin, and may appear as patterns of irregularities or undulations. 16 Vidya et al created a novel grading system for rippling in implant-based complications. Grade 1 rippling, the lowest grade, was defined as no evidence of rippling seen both at rest and with movement, whereas Grade 4 rippling, the highest grade, was defined as severe-persistent rippling causing gross deformity both at rest and with movement.…”

“…Examples of existing treatment options, include implant upsizing, fat grafting, the use of acellular dermal matrix, and maintaining a small pocket. 15 , 16 However, a relatively unexplored area of rippling management is the variation in implant cohesivity.…”

“… 14 If rippling is severe enough, it may warrant surgical correction with implant exchange, pocket conversion, and/or autologous fat grafting. 15 , 16 The purpose of this study is to compare the incidence of rippling and reoperation with autologous fat grafting as they relate to implant cohesivity. We hypothesize that the increased form stability of highly cohesive implants will minimize rippling at the superior pole in prepectoral breast reconstruction and result in fewer reoperations for autologous fat grafting.…”