Causes for breast implant rippling.
There are many factors that contribute to the exiistence or visibility of rippling:
Postion of implant (over or under the muscle)
Position of patient (prone or supine)
Type of implant (moderate or high profile)
Shape of implant (anatomic or round)
Implant material (silicone or saline)
Degree of implant fill (saline)
Soft tissue coverage (
Surface texture (Smooth or textured
Amount of breast ptosis (sag)
Degree of capsule formation or capsular contracture
Weight gain or loss
Depending on the complex interplay of these variables rippling may or may not occur.
To some degree, rippling occurs with all implants but may or may not be visible with changes in position, time, or even weight.
It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the below link.
Rippling is less likely with silicone and also when placed under the muscle. Smaller implants may be better than larger ones. But, you can not avoid it completely.
Chances of rippling with 213 cc Breast Implants
There is a 100% chance of rippling.
"My doctor told me that due to my extreme thinness and thin skin, rippling on the sides will definitely occur" - He is honest and truthful.
ALL breast implants produce ripples - but some produce less ripples than others AND in some people such ripples are less visible and palpable than others.
In general, saline filled implants ripple more than do silicone gel implants (Just fill a ziplock bag - hold it by the bottom and see for yourself). The more cohesive gel implants produce less implants BUT the more cohesive they are the differ they are as well and begin to fill very unnatural.
The question you should be asking is : "How much coverage can my current breast diameter provide to cover up an implant sitting underneath it to cover and soften such potential rippling?"
1. That is the MAJOR reason why implants are placed under the muscle
2, the wider / larger your breast tissue, the wider the implant that would look natural under such breast without the tell tale rippling of an implant that is too large especially when leaning forward without bra support.
So - I would recommend gel implant placed UNDER the muscle and sized by your current breast coverage. That is sure to minimize the extent of visible and palpable rippling.
It sounds like you are dealing with an honest Plastic surgeon who is not trying to "sell you". You may want to listen to him even if you do not like the answer. You will come out ahead in the long term
Breast implants to avoid rippling.
1) Rippling can be avoided by picking the right shape implant. In Manhattan, we have not seen rippling with high profile silicone gel implants. It is also very, very rare with moderate PLUS profile silicone implants.
2) So these are the two shapes we use for breast augmentation. We don't use moderate profile, because these are underfilled, and will cause rippling.
3) We use smooth walled implants, because textured implants can cause more rippling.
4) 213 cc's may be too small for you. Size has nothing to do with rippling.
Avoiding rippling using Silicone Gel Implants
Placing Silicone gel implants submuscularly will definately lower the risks of rippling and palpation. Using a modest size implant in between 200-300cc's will also help lower the chances of rippling to occur.
Rippling and breast implants
I think the advice of a modestly sized implant coupled with partially sub-muscular are your best options to minimize the reisks of rippling. I would tell you that the chance of rippling in the upper and inner breast in the properly placed implant with that size is quite low. The lower and later breasts is wher eyou may see rippling but chance are not high that it will be significant. As your plastic surgeon discussed with you, the larger the implant you go with the greater the chance of rippling. I hope this helps