Breast Implant Rippling Normal?

Unfortunately, saline implants lead to varying degrees of wrippling.  Over the muscle, the number probably approaches 100 % on some part of the breast.  Under the muscle which is usually a partial submuscular pocket, you will see wrippling laterally above the crease because there is almost never muscle coverage here.   This wrippling is often enhanced especially if you are bending over to get something off of the floor. 

Most women with implants do not develop rippling.  It does occur, but not inmost women.  If there is adequate tissue coverage, the risk of rippling is lower.  The newer implants also have a lower tendency to ripple based on improved design characteristics.  If you are going to have rippling, it likely doesn't matter whether you chose saline or silicone.

Thank you for your question.All implants experience rippling, but to various degrees. It is just a matter of whether one can see them or feel them. Visible rippling is an issue for most patients, and if you cannot tolerate it, then you may not be a good candidate for breast augmentation, and fat transfer breast augmentation may be a better alternative.Saline implants are indeed more prone to ripple compared to silicone implants because it is not cohesive like silicone. Let us understand rippling a bit better.Rippling is the appearance of ridges, wrinkling, or scalloping on the implant that may be visible through the skin. It often develops on the outer perimeter of augmented breasts: on the side, bottom, or in between the breasts. Rippling can be caused by the under-filling of the implant, or because of pull on the tissue capsule that is attached to thin overlying soft tissue (i.e., skin and subcutaneous fat tissue, and breast tissue). Unfortunately, rippling worsens with time as the implant puts pressure on the breast tissue and thins the overlying tissue. Rippling is common in patients who are very skinny, have very little fat to hide the implant, and have small breasts compared to the implant itself. Weight loss may worsen the situation.To correct rippling there are solutions depending on their applicability:If someone has under-filled saline implants, have them over-filled moderately.This is more of a preventative measure. Over-filling prevents the shell from folding onto itself although, it can result in unnatural firmness.If someone has textured implants, have it changed for a smooth surfaceIf someone has large implants, have it changed for moderate sized implants so that breasts can better conceal the implantIf someone has saline implants, have it changed for a silicone implantIf someone has the implant placed above the muscle (subglandularly), then have it placed behind the muscle (submuscularly)Saline implants ripple more over the muscle (subglandularly), but the rippling can be hidden behind the pectoralis major muscle due to a thicker layer of soft tissue that conceals 2/3rd of the top of the implant. Rippling may still appear on the outer side of the breast, just above the breast fold and this is especially true if you lean forward or bend to pick up something off the floor.Final 2 solutions can be applied in any case:Weight gain – weight gain will allow greater soft-tissue coverage – i.e., padding – the better the implants and rippling is concealed.Fat transfer to the breast soft tissue for additional support and volume to area where the implant is visibleThis is the only surgical option, but there is unpredictability in the outcome due to less than 60% fat graft take. Also note that rippling is often a problem for thin patients, and such patients have very minimal fat for fat transfer.Now silicone may be scary at first, but rest assured that silicone gel implants are safe and have been FDA approved since 2006. They feel more natural and breast like than saline implants. You can have a very attractive and natural result without any significant rippling: Silicone implants are safe devices which have undergone extensive study. The complication rate from silicone implants is no higher than saline implants. The biggest difference is that the incision is slightly larger with a silicone implant and the current FDA recommendation is to have a MRI 3 years after implantation, and subsequently every 2 years. However, many surgeons do not encourage asymptomatic women with silicone implants to undergo frequent MRI surveillance due to out-of-pocket costs.Regardless of which device you end up choosing, it is important to consult with a board certified plastic surgeon when discussing your options.

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 implantsLarge implantsThin patients with low BMIImplants placed above the musclePrior history of ripplingFactors which are less likely to have rippling include:Heavier and larger breasted womenUsing a highly cohesive form-stabile silicone implants (gummy bear)Smooth implantsSmaller implantsSubmuscular placementOnce 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.#rippling#breastaugmentation

Thank you for your question. Rippling can be seen when the surface of an implant shadows through the tissue, often found where the breast tissue coverage is thin. Some implant styles are more prone such as an overfilled saline implant. Others are less prone such as a shaped silicone implant. So one approach is to change an implant to one that is less prone to rippling. Another approach would be to add some thickness to the breast tissue. This can be done by fat grafting where fat is carefully layered between the skin and the implant. Another is to add a dermal matrix sheet between the breast and the implant where the rippling is visible to blunt the impression of the implant on the overlying skin. If you notice the rippling soon after surgery, I often recommend waiting until around the six month mark as your breasts may continue to change during that recovery period. I would visit with a board certified plastic surgeon to discuss your options in more detail.

Not every patient experiences visual or palpable implant rippling, although there is a greater chance for rippling with saline implants due to their border shape.  I do believe that patients who opt for saline implants should be prepared to at least feel these ripples, even if they are not visible.  I would recommend any patient interested in a breast augmentation procedure to explore the option of silicone gel implants as well, since they have a lower risk of palpable or visible rippling and tend to do much better and feel much better long term.  The amount of breast tissue a patient has prior to breast implants, placement of breast implants (above or below the muscle), implant size, implant profile, implant fill, if saline implants are selected, and surgeon expertise can all affect the overall result and the chances of a patient will experiencing rippling.  I would recommend consulting with a board certified plastic surgeon who specializes in breast augmentation/breast implant procedures and routinely uses both saline and silicone implants.  Addressing your concerns in addition to conducting a physical exam and discussing what size you are hoping to be will help determine whether or not saline implants are the right choice for you.  Best of luck!