How Can You Distinguish Between Rippling and Rupture?

How Can You Distinguish Between Rippling and Rupture?

Doctor Answers 8


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.


Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

How to distinguish riplling from ruptured implants

For saline, a ruptured implant will result in deflation and within a couple of days the breast will lose considerable volume, you won't require medical expertise to realize that something is wrong.

With silicone implants, it is more difficult. If there is any question on the part of your plastic surgeon, an ultrasound is about 85% accurate in making the call for a ruptured implant, if not, then an MRI is quite useful.

Mark D. Epstein, MD
Stony Brook Plastic Surgeon
5.0 out of 5 stars 238 reviews

Rippling of breast implants vs rupture

Rippling refers to a waviness that is sometimes visible after breast augmentation if the implant is underfilled or the tissue over the implant is thin. To some extent this is an exaggeration of a normal phenomenon that occurs in the breast as the breast moves and is due to the ligaments that holds the breast tissue in place. A rupture of a saline implant results in the breast losing volume and becoming small again. A rupture of a silicone implant cannot be seen or palpated. The only way to identify this is, perhaps, with an MRI (Magnetic Resonance Image). A rupture in the newer cohesive gel implants may not even be identifiable with this.


Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Rippling vs rupture

Rippling is the ridging that develops with an intact implants that is felt or seen through thin skin.  A rupture is often seen as a deflation of change in shape of an  implant. An MRI is definitive to detect a rupture for a silicone implant.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Rippling and Rupture of Breast Implants?

Thank you for the question.

Rippling refers to the visible or palpable “waviness” of a breast implant.  This may be seen with any type of breast implant but is more common with saline  breast implants and more severe if an implant is deflating ( compared to a appropriately filled implant).

Palpability  and rippling of breast implants may be related to several factors. These include the amount of soft tissue and breast tissue coverage over the breast implants, the position of the breast implants (submuscular versus sub glandular), the type of implants (saline versus silicone), and the degree of overfilling of saline filled implants. Generally, weight loss will extension weight any rippling/palpability  of the implants.  Deflation of the implants will also increase the rippling/palpability of the implants.

Correction of the rippling may involve further surgery including implant pocket exchange if possible ( sub glandular to submuscular), implant exchange if possible (saline to silicone), and/or the use of allograft to provide an additional layer of tissue between the implant and the patient's skin. Patient weight gain (if possible) may also be helpful.

Breast implant rupture (if saline)  may present with a changing breast size  or shape and increased breast implant rippling. It usually becomes very clear clinically when a saline breast implant is leaking. Sometimes however it may take a few weeks/months for the implant to leak completely. This leakage does not cause any harm to the patient's well-being.

On the other hand, detection of a silicone breast implant leak may not be possible clinically. An MRI study may be indicated.

Consultation with a well experienced board-certified plastic surgeon may be helpful.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Rippling and rupturing

Rippling is an obvious symptom which reflects a capsular contracture. If an implant were to rupture, in a salne implant, you would notice obvious flattening of the breast. WIth silicone, it can be more difficult to tell. That said, I have seen situations which appear to be ruptures which are not corroborated by MRI. The implant manufacturer will not honor its warranty if, upon analysis, the implant is not found to have ruptured so I now send patients who have health insurance for MRI so they can know, in advance, whether they are likely to recoup some of the costs of implant exchange. My recommendation, if the question is not academic, would be for you to see a board certified plastic surgeon in consultation. Best of luck!

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 40 reviews

Rippling or Ruptures

The best advice is to return to your plastic surgeon for an evaluation.  If you have saline implants, the breast size would actually shrink as the saline is absorbed back into your body.  If you have silicone implants the shape may change but the size would remain fairly stable.  Rupture is a very rare occurrence but can easily be corrected with a much less extensive procedure than your original surgery.  If you post before and after pictures, we may be able to give you more advice.


Good Luck.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

Ripple or a rupture can be hard to tell

Developing ripples in an implant can mean a leak or rupture. A saline implant will ripple excessively as it eventually goes flat. A gel implant may begin to ripple with a leak as the breast capsule tightens and creates folds in the gel implant. Of course over time your breast tissue may thin and the ripple within both a saline or gel may begin to 'show through'. The cause can be hard to tell and you might want your surgeon to have a look.

Best of luck,

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 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.