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Research

Scar Tissue Flaps for the Correction of Postimplant Breast Rippling
Massiha H (Louisiana State Univ, New Orleans)
Ann Plast Surg 48:505-507, 2002


Figure 1 - A, B & C
FIGURE 1.-A, A schematic view of the rippling skin over the implant (preoperatively). B, The flap o: capsular scar tissue with the lining of adipose and soft tissues is elevated from thicker areas, is hinged on it: base, and is sutured in place. C, Final stage before insertion of the implant. (Courtesy of Massiha H: Sca: tissue flaps for the correction of postimplant breast rippling. Ann Plast Surg 48:505-507, 2002.)

Background

Palpanle implants under the skin, which are usually also visible as rippling and festoon-type deformities, are relatively common. The etiology of postimplant breast rippling includes an extremely thin individual, the type of dissection, and possibly the kind of implant and the total amount of fill. Outcome may also be influenced by the type of filling material used, whether saline or silicone. Rippling is more common in cases of implant exchanges, particularly with extensive capsulectomy. Two methods for the correction of postimplant breast rippling after breast reconstruction or in cases of primary or secondary breast augmentation are presented in this report.

Methods

The first method is an ideal approach and is both safe and effective. In this method, the thin area is covered with a flap or flaps of scar tissue from adjacent areas folded in on its base and doubled to thicken the affected areas. The flap could be brought in from the thickest parts under the mid breast and, whenever possible, from the chest wall (Fig 1). The second technique relies on transplanting fat into subcutaneous areas of the affected site.

Results

Complete correction of rippling is possible with the ideal technique described here. The author has used fat transplantation only in patients in whom the extent of the deformity covers such a large area that flap coverage is not feasible. The 1 patient in whom fat transplantation was used had significant deformities that were disrupting her social life. Results in this patient were excellent after 3 years.

Conclusions

Postimplant breast rippling can be corrected by rotating a flap of scar tissue from thicker parts of the breast to the thin, affected areas. The technique is simple to learn and provides excellent results. In addition, fat grafting was successful in a patient with severe rippling deformities in all areas of the breast. However, fat grafting is reserved only for the most extreme cases.

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