I have a consultation in a couple of weeks for Saline breast implants but I recently read an article which said that most women with implants will develop some type of rippling. Is this true? Will this happen right away? I would rather not have implants at all if there is a good chance of rippling. I am a size B now and will be going to a full B/small C. I would rather do Silicone for the feel, but am scared to. Thank you.
Breast Implant Rippling Normal?
Doctor Answers 59
Wrippling is common
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.
Having used saline breast implants for many years, I can say this depends upon a few things:
(1) Haw much tissue you have to cover the implants - the more the better as more tissue hides the implants better.
(2) How large an implant model you choose - the larger the implant the more likely the rippling.
Rippling is just one of the signs of implants seen when the soft tissue coverage is on the small side. I have had very few problems with rippling using saline-filled implants when the patients have gone moderate on the sizing.
Important distinction is visible vs. palpable rippling of saline implants
All saline implants have ripples in their envelopes based on the geometry of the implant, the physiology of a fluid- filled "sack" (which is really what a saline breast implant is), and gravity affecting the position of the implant on the chest wall...it's really just a matter of whether one can "see" or "feel" them.
In order to lessen that to some degree, most of us "overfill" the implant "shell" a bit to try to lessen that; however, they are usually still present but maybe to a lesser degree at certain volumes. In most cases, these ripples are not really a problem if the implants are placed in the submuscular pocket.
One of the many reasons I advocate submuscular placement of the implant is that it provides a "thicker" layer of soft tissue (breast tissue and muscle) to cover over the implant. Since the muscle only covers the top 1/2 to 2/3 of the implant "pocket", at times, there can be some palpable rippling at the bottom near the crease under the breast, but this is rarely bothersome to patients once pointed out since it's not in a really noticable place because with deep palpation (pressing your fingers into the tissue) under the breast you might feel something...but you usually don't see it. .
The kind of rippling that patients find most objectionable is visible rippling of the implant. This is more common with saline implants placed in the subglandular pocket (or over the muscle) and in those placed in very thin patients with very little breast tissue. The solution is often to change the implant to the submuscular pocket and to change from a saline implant to a silicone gel implant.
It is true that silicone gel implants cause much less rippling than saline implants, but they too can even sometimes have palpable ripples. Silicone gel implants are safe and have been FDA approved since 2006. They feel more natural and breast like than saline implants. To allay your fears about possible silicone gel implants, I would recommend you to the website www.breastimplantsafety.org which was created by the American Society of Plastic Surgeons to educate the public about breast implants.
I hope this helps
James F. Boynton, MD, FACS
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Rippling risk and breast implants
There are many factors that can affect the risk of rippling. The most important are the quality and thickness of a patient's skin and tissues, the choice of implant type and size and the technique used by the surgeon. While a patient has no control over the first factor, she can certainly minimize the risk of rippling by choosing a denser cohesive silicone gel implant that is not wider than her natural breast and by having the implant placed beneath the muscle.
While the choice of implants in the U.S. is more limited, in Montreal breast implants that are the least likely to ripple are available. These are the "form stable" or tear drop shaped implants (Natrelle style 410) that have the densest silicone of all and the new Natrelle Inspira round implants, which are slightly less dense. While no implant is "ripple-proof", these latter implants are an excellent choice, especially for thinner patients.
Implant Rippling can be Insignificant
You can have a very attractive and natural result without any significant rippling:
- Silicone implants will have far less rippling than saline
- Implants placed under the muscle have less rippling
- If the width of the implant is less than the width of your natural breast, you are much less likely to have palpable ripples
Almost every woman will have some degree of palpable (not necessarily visible) rippling in the breast crease.
If you know you cannot tolerate rippling you may not be a good candidate for breast augmentation.
Information on Breast Implant Rippling
Breast implant rippling is a common occurrence that can happen with either saline or silicone implants. It is more common with saline due to the inherent fluidity of saline in comparison to the cohesiveness of silicone gel.
Rippling is a result of seeing and feeling the natural folds of the implant. Thus, situations where the coverage of the implant is less, rippling becomes more apparent. For example, in women with small breasts and thin tissues, we recommend placement of the implants underneath the muscle. This helps conceal the implant to reduce the incidence of rippling.
Other ways to combat rippling include overfilling the saline implants. This decreases the ability of the shell to fold on itself by increase the volume within the implant. However, overfilling can lead to other unwanted problems such as scalloping (think of this as a ripple that is firm) and an unnatural firmness.
When rippling is a large concern, I usually recommend silicone gel implants. These are safe devices which have undergone extensive study. It is important to understand the science and research behind what the real risks of silicone implants are. You may find that your "fears" are unfounded. Regardless of which device you end up choosing, it is important to consult with a board certified plastic surgeon when discussing your options.
Most saline implants will have some ripple over time.
Most patients with very minimal breast tissue will notice ripples with a saline implant. We always recommend silicone implants for women with very small breasts or thin skin on the breast. Even if the implant is behind the muscle, ripples can develop. Make sure that your physician overfills the saline implants. You should not be afraid to have silicone implants. The complication rate 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 within 5 years of your surgery to evaluate the implants.
Rippling is common with saline implants and very rare with silicone implants
If you are getting saline implants, you should be prepared to accept some rippling. Rippling, when it happens, is usually only palpable but not visible. Many women are happy with saline implants inspite of some rippling. It can be visible, and this is distressing, specially in the cleavage area.
There are two things which can be done to minimize the risk of rippling. The implants should be overfilled and also avoid textured implants. Use smooth walled implants instead.
With silicone implants (which by the way are really safe), I use moderate plus profile or high profile implants. If you use low profile or moderate profile silicone implants, it is also possible to get rippling, because these implants are relatively underfilled.
Breast Implant Rippling
Rippling from breast implants can occur from both saline or silicone implants. It is more commonly seen in patients who have had excessive release of the pectoral muscles medially and are very thin with little to no breast tissue medially as well as laterally. It really depends on the habitus of the patient, the amount of breast tissue. Ideally, in a patient that has a moderate amount of breast tissue, saline or silicone implants are fine. One can always feel breast implants in the outer lower breast pole with both saline and silicone implants. If a patient has almost no breast tissue, I do recommend patients place implants below the muscle and to consider silicone over saline. FDA approved implants (saline and silicone) have excellent longevity, but they do need to be replaced in 10-15 years.
Most saline implant patients will have ripples if they carefully inspect their implants
Though it doesn't bother most of them enough to switch to gel, most saline patients will have palpable wrinkles and ripples along the outer side of their implants especially if they lean forward. This is true even under the muscle and more so if they are thin and have minimal breast tissue. Modest overfilling of the implants doesn't change this either.
The gels are the way to go if this would bother you. If it wouldn't, stay with the saline. Remember that from 1991 to 2007, there were tens of thousands of happy saline breast augmentations done when the gels were off the market. Extremely few of these people have switched to gel now that they are considered safe by the FDA. So you can be happy with saline, they just don't "feel"quite as natural as the gel.
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.