Best Breast Implant Type and Placement to Avoid Rippling?

I am currently looking at two doctors for breast augmentation, both of which are very good. I am 5'2" 93 lbs. One doctor is very adamant about me getting high profile silicone implants under the armpit because he was sure I would ripple with saline implants. The other doctor thinks I should do saline through the nipple.

Has anyone similar to my size and height had breast augmentation and can give me any advice? I know both doctors are fantastic but can't decide which procedure is best for my body type not to ripple. I am also olive skinned and am worried about noticeable scarring.

Doctor Answers 14

Rippling is only one variable

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Patients have to remember a couple of things about breast augmentation. The first is that it is an imperfect operation with an imperfect device. That is, there is always going to be a risk or potential complication that we know about and need to discuss with the patient. One is the fact that all implants ripple. The other thing is that implants can not be totally compared to each other such that one is better than another. You can only discuss implants relative to individual characteristics. So an implant that may be "better" than another as far as rippling is concerned may have other characteristics such as risk of leakage or firmness that makes it ":worse." For example, an underfilled implant has more ripples that you can "blow out" by overfilling but that makes it firmer. You have to look at the totality of the operations the characteristics, and the risks and prioritize each. If rippling issues are more implrtant that leakage issues, then you might choose silicone gel over saline. If minimizing ripples is more important than size, then you might choose a smaller implant that fits the natural dimension of your breasts over a larger implant. If you don't prioritize from the beginning you might end up chasing the imperfections: and go from one operation and one implant to another trying to get rid of each imperfection you encounter.

In general to minimize rippling, choose silicone gel over saline, submuscular over subglandular, and smaller/narrower/less projecting vs. larger/wider/more projecting.

Beverly Hills Plastic Surgeon

No one perfect solution

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There is no way that anyone on here can give you an absolute answer without examining you.

In general, silicone implants under the muscle will ripple the least. The smaller your breasts are to start, the more advantages silicone will offer you.

Incision location is up to you and your doctor, but each has pro's and con's. I personally feel that the imframammary crease incision offers the best advantages for most patients, but not all. In the end, incision location should be an informed choice you make.

The profile choice of the implant should depend on the implant size you choose and the base diameter of your breast.

If you are still confused or unsure, do not be hesitant to seek another opinion.

Best of luck!

Dean Fardo, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 15 reviews


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Breast Implant Rippling most often occurs when there is insufficient soft tissue coverage due to little overlying body fat and breast tissue. Implants placed beneath the muscle help to minimize this phenomena but the lower and outside breast (as pectoralis muscle is no longer present), towards the cleavage where the muscle thins out or on top of the breast where breast tissue is often lacking are the most common places to see rippling. It is often accentuated with certain positions (e.g. bending over,or leaning). Most of the time, rippling is felt along the outer side of the breast and the inner side of the breast next to the cleavage. Breast implant waviness (rippling) that is felt but not noticeable to the eye is very common and should not be a concern. However, when rippling is visible, patients are often self-conscious about their appearance.
Factors that are associated with increased rippling include:
  • Traditional Saline implants (IDEAL® Saline implants less likely)
  • Textured implants
  • Large implants
  • Thin patients with low BMI
  • Implants placed above the muscle
  • Prior history of rippling
Factors which are less likely to have rippling include:
  • Heavier and larger breasted women
  • Using a highly cohesive form-stabile silicone implants (gummy bear)
  • Smooth implants
  • Smaller implants
  • Submuscular placement
Once rippling occurs it is very difficult to correct. Rippling can be minimized by placing a biologic fabrics (e.g. AlloDerm®, Strattice™, SERI®), submuscular conversion if implants are above the muscle, fat transfer, use of adjacent tissue (muscle or fascia) if available, and in persistent cases implant removal and fat transfer. Seek the care of the best board certified plastic surgeon possible with experience in breast revision surgery.


Many factors to consider with breast implants

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There are many factors to consider with breast implants, including your anatomy, the thickness of your tissue, the current and desired size, etc. In my opinion, silicone under the muscle gives the best results in most cases. However, every surgery must be individualized for the patient. Good luck with your surgery.

Rippling and breast implants

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All breast implants have irregularities when positioned. Most of the time they are invisible, obscured by the native breast tissue and subcutaneous fat. Saline implants, because their viscosity is very different from fat and breast tissue, are more likely to exhibit the irregular contour because of the significant transition in viscosity from breast to implant. Therefore, the more of the patient that can be placed over the implant, the better. In my opinion, saline implants are best positioned below the muscle.

Silicone matches breast viscosity closely, so implant irregularities are more uncommon. I see no appreciable advantage (relative to contour irregularities) above or below the muscle.

Rippling and implants

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Silicone under the muscle tends to ripple a bit less than saline. It is all about soft tissue coverage.  Go with the doctor you feel most comfortable with. Pick the implant that you prefer. 

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

It's a lot more than just the type of implant

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The type of implant matters a lot, but it is not the only thing that affects the problem of rippling.

The first priority in avoiding rippling is to have a maximum amount of tissue coverage. A big implant under thin tissue will always have more rippling issues than a smaller implant under thicker tissues.

For that reason, you should go behind the muscle. And you should avoid a large implant and a high profile implant, as I believe that to do so stretches and thins skin and permanently thins breast tissue, thereby making the implant more visibile in the long run.

As for the device itself, choose a smooth walled silicone over anything else. If you can wait, perhaps high cohesive implants will be approved before too long, such as the Mentor CPG and Allergan 410, both of which ripple far less than even existing silicone implants.

So long as your surgeon does a very precise and accurate dissection, the incision in and of itself doesn't much matter in this regards.

The biggest problem I sense for you will be the tendency to go too large.,,,as petite as you are, you must be very conservative about size!

Steven Teitelbaum, MD
Los Angeles Plastic Surgeon
4.6 out of 5 stars 49 reviews

Silicone is less likely to show rippling

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You are a thin woman with minimal breast coverage. Your best bet will be a partially under the muscle augmentation. The scar choice will be up to you. Your areola may be too small to place a silicone implant through so your choice is under the breast or through the armpit and some surgeons don't place silicone through the axilla. Either way you look at it there will be a scar and there can be no guarantees as to how it will heal. Look at your surgeon's patient photos to help make the decision. Best of luck.

Dr Edwards

Silicone breast implants, but probably not through the armpit.

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Hi! Here are 2 facts that should help you:

1) Silicone breast implants are very safe, and they have a much, much lower risk of rippling than saline breast implants. I don't think I have ever seen rippling with high profile, smooth walled silicone implants, and I have a pretty big experience.

2) It's seldom a good idea to put in breast implants through the armpit, because there is a higher risk of bad shape (implants too high). If a breast augmentation patient is not happy, it is most often because of poor shape. The scar is almost never an issue.

So what would I do? Without seeing you, I would use high profile silicone implants through the nipple. And don't go too big! No more than 200 cc's for someone as tiny as you, or you will really look fake.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Silicone would be your best choice

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In most Plastic Surgeons' experience, silicone implants have a much lower tendency to ripple. I always advise a thin, small breasted woman to have silicone implants under the muscle. The incision site is of little consequence. The nipple scar usually heals the best and does not need to be any larger for silicone vs. saline. Sensation changes are the same for all incisions.

The high profile vs. moderate profile is based upon your chest diameter and the ultimate final size of implant you are choosing. Under 350cc, either profile would work. If you get into a larger size, your chest diameter may not allow a wide implant, and the smaller diameter of the high profile will work best.

Good luck with your decision and surgery.

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.