Why Am I Experienceing Rippling 7 1/2 Weeks Post Op from Lift and Implants?

I had cohesive gel implants over the muscle (right side 304 left side 339) with a lift (lolipop incision). I am thinner, 5'7" about 132lbs, I just noticed rippling over a week ago, more so on my left breast. The rippling is on the side and bottom especially when I bend forward. The implants seem to sit lower than my breast crease as I can feel them standing straight up. I go back to see him next week to address this but would like to know if this is his fault, and what my options are?

Doctor Answers 17

Rippling of Implants 2 months after surgery

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That's one of the con's about having the implants placed subglandular.  When implants are over the muscle, they are only covered by skin and fat. If the patient is thin and doesn't have a lot of their own fat, there is a likely chance of rippling. 

I strive to put implants behind the muscle (submuscular) or dual-plane (partially under) when I can. I rarely recommend over the muscle unless the patient has significant amount of their own tissue.

Having said this, over the muscle isn't wrong. Every way has it's pro's and con's.  

Rippling after Breast Implants

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Rippling of breast implants may be related to several factors:

  • amount of soft tissue and breast tissue coverage over the breast implants.
  • submuscular or subglandular position of implants.
  • type of implants: saline, silicone, double gel (Natrelle Style 510).

Rippling occurs in 5%-10% of breast augmenation surgeries. Patients with a thin complexion, have more possibilities of having a noticeable postoperative rippling.

Rippling -in selected patients- can be improved with some surgical manouvers:

  • implant pocket exchange if possible from subglandular to submuscular.
  • Exchange the implant if possible (saline to silicone -preferably the most cohesive gel - TruForm3-). A double gel implant is a good option (Natrelle 510 in Europe).
  • Allograft use between the implant and the patient's skin in selected areas.

All these "advices" are theoretical. Your plastic surgeon is the best doctor to evaluate your clinical options.

Enrique Etxeberria, MD
Spain Plastic Surgeon

Rippling after breast augmentation

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This is normal as your tissues relax and accommodate the additional volume of the implants. It is more common in patients with thinner skin and less of their own natural breast tissue.

Breast Augmentation

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All implants have wrinkling. If you visit your surgeon's office to try on sample implants, whether saline or silicone, they all wrinkle when you hold them in your hand. Wrinkling is less obvious with silicone implants. So you can at least feel good that you chose cohesive gel silicone. On your preop photo, your breast tissue is thinned.  Your tissue is evidently thin enough to allow the wrinkling to be visible. Wrinkling may be part and parcel of having the implant, especially if you are thin. Wrinkling is at its worst when you lean forward because this makes it more obvious.  Additional surgery to place a sheet of tissue (biodermis) can be done to improve wrinkling, but this is costly. You have good nipple placement and received a nice lift.  I would be pleased with your change.  All the best, "Dr. Joe"


Rippling after implants and lift

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Sounds like you have thin skin and your implants are above the muscle.  This is a difficult problem and may require camoflage by use of an acellular dermal matrix.  Donald R. Nunn MD  Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 51 reviews

Rippling of breasts because implants are in front of the muscle

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Though rippling is far more common with saline implants, the reason that you are experiencing this issue with silicone implants is that your implants are above the muscle rather than behind it. Your skin and breast tissue are extremely thin and there is very poor elasticity - so this problem will not go away. A better solution would have been to place the implants in a submuscular pocket (behind the muscle) where there is more tissue between the implant and your skin. This position also allows for better support of the implant at least in the superior aspect of your breasts.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 reviews

Rippling and implants

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Implants above the muscle, have a higher risk of rippling in the superior pole because there is less soft tissue coverage than under the muscle, but the inferior pole is always more palpable.  Sometimes strattice can be used to camouflage the rippling.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Rippling is a Much Greater Risk with Implants above the Muscle

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Hi there-

The short answer to your question is because the implants were placed above the muscle.

You should discuss this with your surgeon as I would not expect it to improve by itself.

Implants over the muscle are more likely to ripple

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It is important you discuss your concern with your surgeon, but implants above the muscle in someone as thin as you have a much higher chance of wrippling even if they are cohesive gels. 

Rippling after breast augmentation

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Rippling or wrinkling after breast augmentation can be equally bothersome for patients and their plastic surgeons.  Unfortunately, it is not uncommon.  Some studies put the incidence at nearly 6%.  Rippling is also more common when textured implants are used instead of smooth shelled implants.  I usually tell patients that if they can feel their ribs, they will be able to feel the edges of their implants.  Moreover, if they can see their ribs, they may be able to see the edges of their breast implants.  This problem is one of the primary reasons why most board certified plastic surgeons place implants into a subpectoral (partial submuscular) pocket in that rippling of the superior portion of the breast is decreased.  Unfortunately, a subpectoral pockets does not prevent rippling of the inferior portion of the breast implants in that the muscle usually only covers the top two thirds to one half of the implant. 

Kelly Gallego, MD, FACS
Yuba City Plastic Surgeon

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.