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.
