What is the best way to fix rippling and implant outline with subglandular silicone implants?

I have subglandular silicone implants and have noticed a lot of rippling over the past few years. I am 5'11" and 125lbs and know I don't have the tissue to cover the implant (unsure why my doctor recommended subglandular). I am very self conscious about wearing low cut shirts or bathing suits because the rippling and implant outline. My question is what would be the best way to fix this problem? I have been told strattice to cover the clevage area or simply moving sub-pectoral.

Doctor Answers 16

Fix Rippling and Implant Outline?

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Sorry to hear that you have this problem. This issue is one of the reasons that subglandular implants are not a preferred approach for most surgeons, particularly for individuals with thin tissues. If your silicone implants are several years old then you may not have the latest generation of highly cohesive silicone gel implants which are less prone to rippling, although they are not an absolute guarantee to prevent rippling. Along with switching to a new generation gel implant, switching the implant to the sub-pectoral position (so called dual plane) would be beneficial in terms of correcting visible rippling in the upper pole of your breast and hiding the outline of the implant. While these changes can help a great deal you may still have a problem with visible or palpable lateral rippling, depending on the size of the implant and thickness of your tissues. Some tightening of the implant pocket (internal capsulorraphy) can be of help in diminishing the problem of lateral rippling. 

Placing Strattice in the cleavage area can potentially be of benefit, but Strattice is expensive and takes time to position, so the repair is costly. In addition, Strattice itself is quite firm and not easily deformable (which is why it would reduce rippling) but if your tissues are thin then the Strattice can very likely be seen or felt through your tissues and for this reason I think it is a poor choice. Fat transfer is another option to try to hide rippling and visible implant outline, but it takes a fair amount of fat to really make a big difference, and women with thin tissues often don't have enough donor site fat to be a good candidate for this approach. 

Rippling coverage

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Really, the best approach is to move it submuscular. Fat grafting the edges also works well if you can find a small handful of fat somewhere, even 20cc per side make a huge difference..my gut on this though is that it is a temporary fix and isn't perfect.  Totally against the strattice or ADM as a cover up, as it's only 1mm thick (sometimes even less) which is pretty negligible. I like using the ADM or strattice to help it stay submuscular and in good position, which is sometimes necessary for women with very thin capsules. 

When implants ripple

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your options include going under the muscle or converting to the highly cohesive textured anatomic implants, if healed perfectly, should not cause rippling.  Going under the muscle will not address any rippling lateral and inferior and now you will have to deal with animation deformities, which can be impressive in a bad way.  Get informed and choose what is best for you and your lifestyle.

My sub glandular implants are rippling. What options do I have?

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There are a number of reasons that most of us no longer place implants above the muscle.  And rippling is probably the number one reason.  That being said, there are a few options to address your concerns:

  • Fat Grafting to the breast to provide additional soft tissue coverage and effectively camouflage the rippling
  • Conversion of your implant to a newer, more highly cohesive implant (which have less of a tendency to ripple)
  • Conversion to a sub pectoral (below the muscle) plane to provide additional soft tissue coverage

I hope that helps.  We would love to work with you.  Please let us know if we can help!

Warmest regards,

Gregory A. Buford, MD FACS 


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Your choices to ameliorate the rippling include, 1 placing the implants under the muscle, 2 using a form stable cohesive gel implant such as the Allergan 410, or a combination of these plus some fat grafting of the soft tissues overlying the implant. Best of luck.

Implant Rippling

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Strattice or any of the ADMs have a poor track record with rippling.  The reason is obvious: they are very thin and don't substantially contribute to what your really need: thicker tissue. Fat grafting is a much better option other than a pocket change from over to under the muscle. Best of luck!

Rippling with sublandular silicone implants.

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Thin tissues and oversized implants are two thoughts that I associate with your problem.  I would discuss a change to a partial subpectoral pocket and possibly the use of a smaller imlant IF you have unusually sized implants for your frame.  Fat grafts and Strattice could be additional considerations.

Meet with an ABPS Bd Certified ps to be examined in a face to face setting.

Jon A Perlman MD FACS 

Certified, American Board of Plastic Surgery 

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016 

Beverly Hills, Ca

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 31 reviews

Rippling with subglanduar breast implants

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As the other responses have noted:

1. Change in position to submuscular could possibly help.

2. Fat injections also could help, but they might disappear over time

3. Tightening of the entire pocket with sutures

4. Use of Alloderm, Belladerm or Strattice to tighten the pocket

Hope these ideas help a bit.


Dr. Christine Rodgers


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Thank you for the question and though an examination is needed, the simplest solution is submuscular with more cohesive implants.

Dr Corbin

Can rippling after breast augmentation be fixed?

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To summarize all the other posts, there are many options to fix this problem. All with varying levels of cost in both money and down time, but yes it can be fixed. 

1- fat injection is least down time and lowest cost

2- new implants may fix it alone and a good choice especially if your implants are not very cohesive or if you want a different size. This could be done with may of the other options 

3-site change to subpectoral will help for upper and medial rippling not inferior or lateral. This can be done with or without new implants.  And can be done with fat grafting 

4- yes Strattice will help with the cleavage area but is a lot more money and again can be combined with may of the above. 

Your best option is to get inperson exams and consultations. There are many ways to "skin this cat" and five different plastic surgeons may come up With five different options any of which would Work beautifully.  

Best of luck.

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.