What to Do to Correct a Lot Rippling and Asymmetry in a Very Thin Woman? (photo)

I had a few previous surgeries (to remove capsule and to remove infectious tissue). I currently have textured silicone partially under the muscle (400 and 425 ccs). I have a lot rippling and one of my breast looks larger (400 ccs). I wonder if placing a smooth silicone implant completely under the muscle would help with the rippling and do you think it is possible that the doctor placed the larger implant in the wrong breast? How difficult is to make someone thin like having attractive breasts?

Doctor Answers 10

Thin Patients and Implant Rippling

Hi Latina, I agree with my fellow plastic surgeons on how you need to correct the problems you are having with your implants.  Because of your thin tissues, you lack the necessary camouflage to hide the implant which is why you are seeing the rippling and the implant edge so clearly.  Placing the implant under the muscle only hides parts of the implant but not all.  Borrowing from our breast reconstruction techniques, we can use an alloplastic material-many have been mentioned by other responders to your question-to better cover the implant and make it less visible.  These materials also seem to add some support to the breasts to hold the implant in place better long-term-a problem for many thin patients using a larger size implant.  I agree with changing to a smooth surfaced implant and using a silicone-gel implant-saline implants are much more prone to rippling than gel.  Lastly, it is possible that the implants were mixed up at the time of surgery but more likely is that your asymmetry may require not only a different size but also a different projection.  Hard to tell without before photos.  Please consult with a board-certified plastic surgeon who has experience using the alloplastic materials discussed in all of our answers to your questions.  Good Luck!

Saint Louis Plastic Surgeon
4.7 out of 5 stars 84 reviews

Thin coverage and rippling

I agree with the suggestions of smooth rather than textured gel implants. I would discourage saline and particularly overfilling saline implants. The other options for gaining coverage is an ADM like Strattice that is a sort of a capsule substitute. The only other option not mentioned is weight gain or fat grafting which is still not well established for cosmetic breast augmentation. The volume difference could be positional but there is no simple way to measure or determine the implant size without an open procedure. 


Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

What to Do to Correct a Lot Rippling and Asymmetry in a Very Thin Woman? (photo)Answer:

Breast implants in thin women continue to be a challenge! My feeling is that if you go completely submuscle you may need a lift to deal with the loose skin. I think you will need new implants. A smooth implant covered by Strattice is probably the best bet, but expensive. I have seen some success with Saline implants overfilled to reduce rippling, but not always.  Then there is the option of finding a surgeon here in the states that can use the 410 silicone implants, which seem to ripple less.


John J. Corey, MD
Phoenix Plastic Surgeon
4.6 out of 5 stars 45 reviews

Rippling With Textured Implants...

I agree with my colleagues as to the probable causes of your problem and, also, the methods offered as an attempt to solve it.

Unfortunately, there is no easy answer to this situation. In an effort to correct the visible rippling as well as your asymmetry, I go along with the idea that smooth implants (each of a different size) could provide significant improvement. I believe that, even then, implant visibility with noticeable rippling are likely to persist due to your scant soft tissue coverage.

Your prospect for improvement may be even better if you were treated by a plastic surgeon well versed in the technique of fat transfer to the breast. By means of that modality, it may be possible to thicken the soft tissue coverage and, hence, satisfactorily conceal the underlying ripples.

Best of luck!


Charles Gruenwald, MD (retired)
Baton Rouge Plastic Surgeon
5.0 out of 5 stars 11 reviews

Correction of Breast Implant Rippling

Thank you for the question and pictures.

Yes I think it is possible for a “thin patient to have attractive breasts”. I would suggest exchanging your current implants for smooth silicone gel implants and using allograft to cover the most visible/exposed areas of the breasts  involved with rippling/palpability of the implants.  This procedure should be done by an experienced board certified plastic surgeon. 

This type of surgery along with a small amount of weight gain (?) should improve the situation.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,498 reviews

What to do with rippling

This is a difficult problem to correct especially in your situation.  I am NOT a lover of textured implants They are like sitting on a velvet sofa in corduroy pants - if you try to slide over you zipper ends up on your side.  I have treated a number of patients with your patients with your problem using strattice or alloderm to line the pocket, using silicone smooth implants under the muscle and possibly going to smaller implants as the larger the implant the greater risk of rippling.  You may still have some rippling but I agree with Dr. Baxter that going total submuscular will be difficult painful, and probably no better.  Good luck, Dr. Schuster from Boca Raton

Steven Schuster, MD, FACS
Boca Raton Plastic Surgeon
4.0 out of 5 stars 8 reviews

Strattice to correct rippling with breast implants

Definitive advice would require a personal exam and evaluation, but here are a few things to keep in mind: When the capsule was removed, some of the tissue that would provide coverage to conceal rippling was also removed. Strattice acellular dermal matrix graft replaces this missing tissue. total muscle coverage is impractical and would probably require tissue expansion as in breast reconstruction. Smooth implants ripple less than textured but would not be likely to solve the problem alone.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 53 reviews

What to Do to Correct a Lot Rippling and Asymmetry in a Very Thin Woman? (photo)

In Miami, Best to see you in a consult to discuss. Was your PS a plastic surgeon. Yes the implants could have been mixed up. Rippling hard to correct, very common with textured implants. Look forward to help you. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Correction of Rippling and Asymmetry in Breast Implants

Hi there-

There is no doubt that part of your problem with rippling is due to the implants' textured surface. Texturization used to be thought to limit the rate of capsular contracture, but experience has shown that this benefit is minor to non-existent, and that texturization always increases your risks for rippling...

Placement of a smooth surface implant will improve this- but it may not be eliminated without further intervention at the same time.

Review this with your surgeon- 

Armando Soto, MD, FACS
Orlando Plastic Surgeon
4.8 out of 5 stars 159 reviews

How to correct rippling in the upper pole of the breast.

Obviously an in-person examination is necessary for your particular case, but in general these are the options to correct upper pole rippling:

  • Place the implants underneath the muscle - Although this has been done, it is important to verify that your implant hasn't "flipped" on top of the muscle which can occur if a pocket change was performed at the same time as a capsulectomy is performed in a previous subglandular pocket
  • Increase the size or projection of the implants - This allows for a "filling out" of the pocket to prevent the rippling and pleating occurring inside the pocket.
  • Fat grafting to the upper breast pole - Simply a camouflage technique, but this can help in mild to moderate cases of rippling.
  • Strattice to line the upper capsule - Strattice is a dermal matrix (ie - pig skin), which can provide a more rigid capsule texture and increase the thickness of the upper pole to decrease the appearance of wrinkling.

Texturing is not as important with preventing rippling. As for size, you certainly appear to have a mismatch, and correction with different implants is required. Attractive breasts in thin patients are common, however this becomes significantly more compilcated when a patient has had previous issues with infections and capsular contractures.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 25 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.