How Do You Correct Uneven, Rippling Implants?

Breast augmentation done on Feb 4, 2011. I have 530 left and 540 right moderate profile saline. About 2 1/2 months my right boob starting looking different. Sits lower and no fullness at the top. I am just wondering what caused this and what should be done about this? Also I have a ripple on my other boob in the cleavage area. I believe the dr didnt overfill the implant enough. Are there any options for that?

Doctor Answers 7

Bottoming out and saline implant rippling require re-operation.

Your right implant has begun to bottom out, and you require surgical capsulorrhaphy with cautery and sutures to raise your crease. Over correction is advised as it will tend to drop again, particularly if your surgeon was successful in creating a pocket with a (proper) thin, soft, pliable capsule that yields a soft, natural breast feel. Getting the implant back into its proper position will fill out your upper pole more like the opposite breast.

Saline implants can ripple even if the proper overfilling is performed; sometimes the breast tissue softens more than the mythical "average" and ripples become visible. The best solution for this is to switch to silicone gel implants--this always reduces (and often eliminates completely) rippling, and a more natural-feeling breast is achieved as well! Saline can also eventually deflate, requiring (another) re-operation. Just say "No" to saline.

Acellular dermal matrices can help to reinforce the IMC (inframammary crease) area where you bottomed out, but this is expensive, and it provides no guarantees either. I rarely utilize them for first-time revisions.

You have the potential for a fabulous result, and absolute symmetry is impossible. But much better certainly IS, and you should proceed accordingly! Best wishes!

Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Repair of breast implants and breast implant rippling

I would advise you to consult with a plastic surgeon in order to assess the degree of positional rippling and to determine whether implant exchange is an option.  During this procedure, the breasts implants can be adjusted to obtain more symmetry. 

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Brest implant asymmetry and rippling

Certainly breasts have some asymmetry.  Yes, the one on your right does look slighlty lower which would also mean less upper pole fullness, but certainly within the norm.  RIppling can develop from lack of soft tissue coverage.  Overfilling the implant may improve this or exchanging for silicone or  adding an acellular dermal matrix.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Breast implant asymmetry and rippling

From your description and photographs, it appears that the right breast implant has "bottomed out", in other words, the tissue / skin of the lower portion of the right breast has stretched more than the left, (unless your breasts were asymmetric in a similar way preoperatively - unknown without preop photo).  The position of the implant (above or below the muscle) and surgical techniques are critical to minimizing the possibility of rippling. A patient's skin and breast tissue thickness will also significantly factor in to the possibility of rippling.  Saline implants (especially those 'underfiled) also increase the chance of rippling ( the ability to 'see' the implant edges through the skin) versus silicone implants.  I would suggest discussing your concerns with your plastic surgeon.  If that avenue has already been explored, you may seek a second opinion from a Board Certified Plastic Surgeon.  If I were seeing you, and assuming your implants are submuscular, I would offer you a right capsulorrhaphy (tightening of the tissues around the implant to improve the position of the implants and overall appearance and symmetry of the breasts) as well as possibly filling the implants slightly more or changing to silicone.

Dr. Sean Simon


Sean A. Simon, MD
Miami Plastic Surgeon
4.2 out of 5 stars 36 reviews

Uneven breasts

The issue you have is that the fold under your right breast, for one of a few reasons, is not strong enough to support your implant.  The fold moved down on your chest and it is now a bit lower than the fold on the left breast.  The lower position of the fold allowed the implant to migrate downward.  You will likely feel the implant clearly separate from your overlying breast at the very bottom of your right breast.

The solution to this is stratight forward, but is surgical and involves placing sutures to raise and reinforce the strength of the fold under your breast. 

Scott E. Newman, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 42 reviews

Breast implant asymmetry

It looks like your right breast implant sits lower on your chest wall compared to the left  breast implant. This is referred to as inferior displacement (bottoming out) of the right  implant. Based on your description and picture you may also have medial (towards cleavage) displacement of the left breast implant. This implant positioning causes the nipple/areola  to appear too high on the breast mound on the right.  Furthermore, the nipple/areola  appears to be off centered (pointing outward)  on the left breast mound.

I think the best method to correct the implant positioning is to use permanent internal sutures (capsulorrhaphy). Consult with your plastic surgeon to see if he/she has experience with this type of revisionary surgery. Best wishes

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,484 reviews

You Have Lower Pole Stretch.

The implant on the right shows lower pole stretch due to the size and weight of the saline implants. This often happens in implants that are relatively large in tissue that is relatively thin. You don't mention if you are above or below the muscle. Options include: 1. Tightening of the lower pocket on the right. 2. Make sure the implants are submuscular. 3. Consider a switch to silicone - this will help rippling. Overfilling will help rippling, but will make lower pole stretch worse.

Brian Klink, MD
Vacaville Plastic Surgeon
5.0 out of 5 stars 94 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.