Techniques to Avoid Breast Implant Rippling


Breast implant rippling is primarily caused by insufficient soft tissue coverage. However, careful surgical planning and correct implant volume can prevent or at least minimize such risk.

The most common culprit for rippling is the use of implants that are too large for the underlying anatomy that their edges become visible beneath the skin. For this reason, the amount of augmentation should be within the confines of the breast/chest measurement and soft tissue coverage.

To further minimize the risk of rippling, it is ideal to use silicone implants particularly in small-breasted women. They are made of silicone shell filled with a cohesive silicone gel that feels like the “real thing.”

Saline implants, meanwhile, are only filled with sterile salt water at the time surgery. While women with ample soft tissue coverage could still achieve good results from them, thin and small-breasted patients may have to accept more palpability and possibly some “sloshing effects.”

Despite the perceived cosmetic benefits of silicone implants, they entail long-term “maintenance” through regular MRI scans, ideally three years after surgery and then once in every two years.

MRI scans are used to detect silent gel leaks, which have no visible symptoms.

To avoid silicone gel leaks and the additional cost of regular MRI scans, some women still choose saline implants despite increased palpability.

While it is true that the risk of rippling is higher with saline implants, it can be avoided or minimized by placing them beneath the chest muscle, which can serve as additional soft tissue coverage. It might be safe to surmise that with these implants, the sublgandular—or over the muscle placement—is rarely used.

If saline implants are used, it is important to fill them with the appropriate, manufacturer indicated volume to prevent rippling. However, some doctors choose to slightly overfill them (just about a teaspoon or so) in an attempt to further minimize the risk of wrinkling, which over time can affect the shell’s stability.

Despite all efforts to minimize rippling, some individuals remain inherently prone to this problem—e.g., post cancer patients who had mastectomy and thin “very athletic” women. These patients are suitable for soft tissue replacement such as fat grafting and acellular dermal matrix.
Article by
Beverly Hills Plastic Surgeon