Breast Implant Rippling—What Is the Real Deal?


Breast implant rippling happens when the prosthesis becomes visible and/or palpable underneath the skin; oftentimes it affects the outer edges of the breast where the tissue is the thinnest.  According to a study that evaluated more than 800 patients, its incidence was about 7 percent, with factors such as underweight, lack of breast tissue/fat, use of saline implants, and subglandular technique increasing the rate of complications.

Fortunately, there is a gamut of techniques proven to prevent or at least reduce the risk of breast implant rippling.  With this in mind, the first step is to perform a comprehesive physical exam to determine if the patient’s anatomies can predispose her to the complication.

Women who are naturally thin, small-breasted, and “athletic” are at high risk to visible and palpable rippling because of the “coverage” issue. Simply put, breast tissue and fat serve as an envelope to prevent or minimize this “cosmetic” complication.

As a way to counteract the risk factors stated above, skilled plastic surgeons more often than not recommend the use of silicone gel implants, which are filled with a cohesive gel that feels and behaves almost like the tissue.   Saline implants, meanwhile, might not be a good choice for “high-risk” patients since they are only filled with saline or simply a sterile salt and water solution.

It is not uncommon for women with saline implants to describe their breasts to feel like a water-balloon, which could be more pronounced if they have very little coverage and the implants are incredibly large relative to their underlying anatomy.

Even with the use of silicone implants, it remains important to use a size that is within the confines of the anatomy.  For this reason, prudent plastic surgeons take all the necessary measurements of the breasts (vertically and horizontally, in addition to their profile or forward projection) and consider the amount of existing tissue to determine the “ideal” implant volume.

The goal is to avoid implants whose width and profile go beyond the capacity of the underlying anatomy.

Another rule to reduce risk of rippling is to use the submuscular implant placement in which the device lies underneath the pectoralis major muscle, a thick and strong coverage.  This is particularly critical if the patient has very little breast tissue.

The subglandular implant placement, meanwhile, is to be avoided when dealing with “high-risk” patients because only the tissue and skin act as an envelope.

Occasionally, biomaterials and tissue thickeners such as acellular dermal matrices and fat graft are used to prevent and treat breast implant rippling.
Article by
Beverly Hills Plastic Surgeon