Breast Implant Rippling
July 1st, 2009
A patient emailed me today about “rippling” of her breast implants. Her surgery was done in another office some 10 years ago. This has bothered her ever since, despite a revision surgery to correct the problem. She wants to have something done to reduce the rippling. There are several factors to consider.
Women frequently notice rippling of their breast implants. This refers to the undulation of the breast surface or breast skin above the breast implant. This is a result of fluid movement within the silicone shell. Erect posture and leaning forward seems to accentuate the condition. As the fluid shifts, it changes the shape of the implant from discoid to pear shape. The change in shape results in surface distortion of the implant which show up as rippling.
Women who have minimal breast tissue of their own, may notice this rippling more. Since they have only a thin layer of breast tissue and fat between the implant and the skin, the changes in implant surface are more noticeable. Weight loss may often include reduction in breast substance to reveal rippling or make it worse.
It seems the outer surface of the breast is affected by rippling the most. This is the area where the arm and elbow touch the chest and side of the breast. This location of the implant may only be covered by a thin layer of fat and skin. Larger diameter implants and lateral positioning of the implants toward the armpit, reveal larger portions of the implant into chest areas with less or thinner coverage. Rippling can be seen in the upper inner aspect of the breast. This is the decollete area. Placement of implants beneath the Pectoralis muscle has virtually eliminated this rippling.
Both saline (salt water) and silicone gel implants available in America can show some visible rippling. It is felt less when silicone gel implants are used. However, the most coherent silicone gel products, only available outside the US, may reduce or eliminate rippling of breast implants. Unfortunately, the coherent gel implants currently available in the US do not eliminate this rippling.
Stars Not Scars
June 20th, 2009
Sky News report of a Belgian teenager getting a facial tattoo is remarkable. The teenage girl claims she asked for three stars on her face, but ended up with more than 30 after she fell asleep at the tattoo parlor. She is now stuck with the permanent marks prominently displayed on her face. Even with the best laser removal, there will most likely be some form of scarring of her face and shadows from incomplete ink removal.
Tattoos are a cultural phenomenon. Traditional cultures in the South Pacific have utilized this permanent skin marking for centuries. It is an integral part of who they are. Tahitian tattoos frequently will chronicle a person’s life journey, including particularly notable events. Maori mokos are a sign of social status worn on the face. These are the cornerstones of social acceptance. Captain Cook’s discovery of this practice and subsequent introduction into the western world is relatively recent when compared to these ancient Polynesian traditions. The recent appearance in our pop culture during the past 10 years, can only be described as a fashionable fad. It is hardly part of our cultural fabric and tradition.
The real problem arises when tattoos are chosen outside a real tradition or cultural significance. In the West, relatively little thought is generally given to the ramifications of a tattoo. They may often be chosen on a whim, due to peer pressure or possibly consent given under the influence of chemicals. Ask any World War II veteran about their tattoo and you will usually hear a story of alcohol consumption as part of the ritual. However, for the soldiers, these occasions served as a symbol of their military service and a bond of fraternity.
The young lady who ended up with stars on her face is an extreme example of bad judgement and while certainly tragic, I am skeptical of her story. It is very difficult to fall asleep as she reports, when facial skin is stimulated in this way, unless she was medicated or intoxicated. The account given by the tattoo technician doesn’t match her story, so the actual sequence of events is unclear. None the less, she must live with the consequences.
Tattoos are a personal choice. Just like any cosmetic surgery procedure, really. The long-term implications must be weighed within the society and culture you reside. Gang tattoos are no exception. This was brought home to me while I was removing gang related tattoos as a volunteer, free of charge. The tattoos symbolized the membership in a gang. The people I saw were those trying to break away from gangs. Any visible signs of gang association hindered them in their goal to get a job and start a fresh life. Once the telltale markings were removed, they had a much greater chance at life outside the gangs. Removal is painful and very expensive lasers are needed to lighten the tattoo ink. Several visits are required, making the final bill to remove a tattoo costing several hundreds of dollars.
Unless culturally consistent (Tahitian life event tattoos or Maori mokos), the long term connotation and denotation meanings must be carefully weighed before making any long term or permanent physical changes.
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