Rippling Following Breast Augmentation or Reconstruction: Aetiology, Emerging Treatment Options and a Novel Classification of Severity

Pantelides, Nicholas M.; Srinivasan, Jeyaram

doi:10.1007/s00266-018-1117-y

Cited by 17 publications

(12 citation statements)

References 22 publications

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“…This suggests that the use of ADM may not eliminate rippling completely, as shown in previous studies. 18 Notably, in both the univariable and multivariable regression analyses, rippling was significantly less common in patients who underwent breast reconstruction using the superior coverage technique. Propensity score matching was performed by including all variables that could affect rippling as much as possible and randomized matching with the same number of people could be appropriate for the two experimental groups (Table 5).…”

Section: Discussionmentioning

confidence: 91%

Associated Factors and Prevention of Upper Pole Rippling in Prepectoral Direct-to-Implant Breast Reconstruction

Ryu,

Joo,

Roh

et al. 2023

Arch Plast Surg

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BACKGROUND: Despite its many advantages, prepectoral breast reconstruction also carries the risk of implant rippling. The recent introduction of partial superior implant coverage using a pectoralis muscle slip in prepectoral direct-to-implant (DTI) breast reconstruction has shown the potential to minimize upper pole rippling. The purpose of this study was to identify factors associated with rippling and the effectiveness of our surgical technique. METHODS: One hundred fifty-six patients (186 breasts) who underwent prepectoral DTI breast reconstruction between August 2019 and March 2021 were identified retrospectively. Patient data were analyzed from medical records. Univariable & multivariable logistic analyses were performed to contextualize the risks associated with rippling deformity relative to demographic characteristics and other clinical factors. Retrospective propensity-matched analysis was performed to identify the relationship between rippling deformity and reconstruction method. RESULTS: Patients with body mass index (BMI) (odds ratio [OR], 0.736; P < 0.001), those with a postoperative chemotherapy history (OR, 0.324; P = 0.027), and those who received breast reconstruction via the superior coverage technique (OR, 0.2; P = 0.004) were less likely to develop rippling deformity. The median follow-up period was 64.9 weeks, and there were no significant differences between patients in types of mastectomy, implant, or acellular dermal matrix. Patients who underwent superior coverage technique–based reconstruction showed significantly reduced rippling (OR, 0.083; P = 0.017) CONCLUSIONS: Patients with higher BMI and prior postoperative chemotherapy were less likely to develop rippling deformity. The superior coverage technique can be effective in minimizing upper pole rippling.

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Section: Discussionmentioning

confidence: 91%

Associated Factors and Prevention of Upper Pole Rippling in Prepectoral Direct-to-Implant Breast Reconstruction

Ryu,

Joo,

Roh

et al. 2023

Arch Plast Surg

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“…The impact of this long-term complication on the final aesthetic and functional outcome of the whole reconstructive process has led to the identification of risk factors and the creation of a grading scale, just like for capsular contracture, another complication to which in some respects is related. 3 To treat this contour deformity, several authors have described the use of ADMs both as a capsular onlay graft to increase the thickness of subcutaneous tissues and as a "hammock" fashioned support to the lower pole of the implant pocket. [13][14][15][16] Despite the good results achieved with these devices, the real limitation to their employment is represented by their cost.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Rippling is a possible complication following breast augmentation or implant-based reconstruction and results in significant patient dissatisfaction. 3,4 It consists of implant contour visibility through the skin and appears as irregularities or undulations underneath the skin surface. Both subpectoral and prepectoral (with or without acellular dermal matrices [ADMs]) reconstructions may hesitate in this complication, although it is more frequent in prepectoral implant-based reconstruction, because of the absence of soft tissue coverage and support of the pectoralis muscle.…”

Section: Introductionmentioning

confidence: 99%

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

Faenza

Lanzano

Grella

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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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.

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“…Unlike conventional and recognized emerging health issues, emerging issues are those characterized by low or non-existent scientific knowledge, high levels of uncertainty and different levels of acceptability by the relevant authorities and exposed populations. 24 Although these issues are already well-known issues in breast augmentation surgery, [25][26][27] through open-ended questions of the BREAST-Q IS allows us to listen to our participants' concerns without the risk of potentially precipitating breast implant anxiety. 28 Further, ongoing analysis of participants allows us to monitor for other new or emerging concerns as a means of identifying previously unrecognized potential adverse effects of implants or complications that are not enquired about through the data collection form.…”

Section: Discussionmentioning

confidence: 99%

Patient Reported Outcome Measures After Breast Augmentation – Using the BREAST-Q IS

Jayasinghe¹,

Ruseckaite²,

Gartoulla³

et al. 2022

PROM

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Purpose: Cosmetic breast augmentation procedures are commonly performed breast device surgeries. The Australian Breast Device Registry (ABDR) administers a five-question patient reported outcome measure (PROM), the BREAST-Q Implant Surveillance module (BREAST-Q IS), to patients 1, 2 and 5 years after breast device surgery. The measure includes an open-ended question to add any comments. This study aimed to use the responses to this open-ended question to assess participants' experiences of breast devices 1 and 2 years after breast augmentation. The secondary objective was to identify emerging and important issues relating to breast augmentation and devices. Patients and Methods: This qualitative descriptive study was conducted using a randomly selected sample of 268 responses to the open-ended question in the BREAST-Q IS, from the ABDR database. These responses were from patients who underwent breast augmentation between 2015 and 2018. Comments were analyzed using conventional content analysis in NVivo 12. Results: Four major themes were identified: satisfaction following breast augmentation, dissatisfaction following breast augmentation, complications and breast symptoms following breast augmentation and other comments. Two dominant themes were regarding satisfaction (n = 112) with overall surgical outcome, medical team, and post-operative appearance and complications and breast symptoms (n = 177) following breast augmentation. Emerging issues identified were rippling of breast implants and breast implant illness (BII). Conclusion:PROMs can be used to understand patients' perspectives on various aspects of their own surgical experiences. Participants provided responses regarding complications and breast symptoms experienced, and rippling of the breast implants and BII are emerging issues after breast augmentation.

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Rippling Following Breast Augmentation or Reconstruction: Aetiology, Emerging Treatment Options and a Novel Classification of Severity

Abstract: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cited by 17 publications

References 22 publications

Associated Factors and Prevention of Upper Pole Rippling in Prepectoral Direct-to-Implant Breast Reconstruction

Associated Factors and Prevention of Upper Pole Rippling in Prepectoral Direct-to-Implant Breast Reconstruction

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

Patient Reported Outcome Measures After Breast Augmentation – Using the BREAST-Q IS

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