Hi fstheyn. There are a myriad of reasons for implant rippling. It is not uncommon to see or feel this rippling only on one side. As noted by another physician, implants, de facto, ripple. The saline implants have more of a waviness than silicone, but both implants have rippling. The amount of fill within a given implant, will also effect the degree of rippling -- the higher the fill, generally the less rippling. The silicone implant does ripple less, and the more cohesive the implant, generally the less rippling. The texture of the implant shell can also affect rippling, with the texture tending to ripple more. The position of one's body will also affect rippling, as well as the location if the rippling (especially saline) due to gravity and resultant distribution of the fill material. "Traction rippling" occurs due tethering of certain portions of the capsule/membrane surrounding the tissues and concentration of the fill to the dependent portion of the implant, leaving the top portion of the implant empty. Focal rippling may occur when there are areas of tightness and alternate areas of thinning/expansion of the capsule and scar tissue surrounding the implant. Typically, subglandular (over the muscle) placement will have more appreciable rippling than sub-muscular/sub-pectoral (under the muscle). And most definitely, tne thickness of the overlying tissues will impact to what degree ten rippling is padded vs. palpable and/or visible. Also, most implants placed "sub-muscularly" or "sub-pectorally" are not completely covered by muscle -- the outer portion of the breast is only skin and gland, or even just skin. This is also true for the bottom of the breast if the muscle insertion has been released, as is common practice. Finally, with saline implants, progressive rippling, especially on the top, may be a sign of leakage. As to your specific question, a change in rippling or the pattern of previous rippling with silicone implants, may also represent an implant rupture or break in the shell integrity. This would be a more uncommon sign, but physical exam with silicone implants is notoriously unreliable. Therefore, I would encourage you to follow-up with your surgeon promptly and consider a breast MRI to evaluate your implant further. (And, it is FDA-recommended that a surveillance MRI be performed every two years.). There are a variety of treatment option to try to improve rippling (scar/capsule release and pocket redevelopement if needed, implant plane exchange from subgland to submusc or visa versa, implant type change (e.g. textured to smooth, profile change, increased fill volume, etc.), and fat grafting. Results may be unpredictable and the rippling may persist or recur. If the rippling is only palpable or minimally visible, I would caution against a revision -- "The enemy of good is 'better!'" Good luck!
