Every breast implant has at least a little bit of wrinkling or rippling, an irregularity of its surface. Some implants have very little, and some have a lot of it; if there is little, then it may not even be detectable. If there is more, it may be felt, and if there is a lot of wrinkling, it can be felt and even seen. In general, the degree of wrinkling depends upon several factors that work to either hide or reveal wrinkling or rippling.
Factors that increase apparent wrinkling:The areas where wrinkling is usually most apparent are the outer side near the arm, along the bottom, and towards the cleavage, in that order. In addition, if the implant is not filled up to the optimum, which may require overfill, there can be wrinkling at the top of the breast also. In this case, with the implant not adequately filled, putting the implant under the muscle may hide some of the wrinkling. If the implant is filled to its optimum amount, there is no difference in wrinkling between in-front-of-the-muscle ("Overs") or behind-the-muscle ("Unders").
Every implant has an optimum volume of saline fill, a volume that gives the best balance between either wrinkling (caused by not enough saline) or too firm/round (caused by too much saline). The difference between inadequate volume and the optimum volume is astonishingly small, around 10%, which may be only a couple tablespoons of water! It is quite remarkable that such a small amount of added water can make such a big difference. Women who are troubled with wrinkling because their implants were not filled to the ideal optimal volume may need an operation to add that critical tablespoonful of saltwater that makes all the difference. It is amazing what a difference such a small amount can make. OK, it seems obvious and simple so far, right, just fill the implants to the optimum volume every time so you don't have to re-operate; so what's the problem?
The problem is that for most implants, the manufacturers have registered the maximum volumes too low with the FDA, below the optimum. So if your surgeon stays within the manufacturer's recommended range for these implants, they will wrinkle noticeably, and if the implant is filled to the optimum, it will be beyond the manufacturer's registered maximum, that is "overfilled". So for those implants, the majority of surgeons will overfill, that is, fill to the optimum for minimum wrinkling, even though the manufacturer's maximum is exceeded.
But, as the above lists make clear, it is possible that in certain situations the wrinkles from an underfilled implant may not be detectable, whereas in other situations, even a properly filled implant will have obvious wrinkling. It depends upon which of the factors listed above come into play. It is no wonder a proper consultation takes at least four hours!
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