Fat Grafting to the Breast to Improve Rippling?

I have silicone unders with strattice and still am experiencing rippling medially. My question is do I need fatty tissue in the breast for the fat grafting to attach to and survive?

Doctor Answers 6


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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.


Breast Implant Rippling and Folds Can be Improved with Fat Grafting

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Thank you for your question.

In my experience Fat Grafting works very well to correct surface irregularities, Rippling and Folds in patients with Breast Implants.

This avoids the need to do open surgery which is a distinct advantage.

Be sure to find someone who has experience with this relatively new technique.

We use the Adivive Fat Harvesting System to improve the viability of the Fat Cells that are harvested

Rippling with breast implants

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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 what you have already tried, 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. I would revisit with your plastic surgeon to see there is benefit to place additional dermal matrix medially.  

Fat grafting versus form stable implant

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Its sounds like you have already done most of what is available to you to reduce the rippling or implant visibility including having the implant under the muscle and the use of acellular dermal martix.  Your options that remain include fat grafting which can work well when performed properly, gaining weight which is never really an option than any patient opts for :), and the use of form stable implants.  Implants such as mentors 410 implant is form stable which means that it is firmer and maintains its shape no matter what position it is in.  It tends to have less folding irregularities since it is firmer.  It does requires a very specific pocket to be created and this may no longer be an option for you but I did want you to know about it.  The implant is set to be released for general use in the very near future.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Textured breast implants increase your risk of rippling.

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1)  Skilfully done fat grafting will definitely help with rippling.  But I have two questions.

2)  Do you have "moderate" profile implants?  These are mislabeled (don't ask why; it is a political issue with the FDA).  They are really under-filled low profile implants which can produce rippling.  If you do, switching to "moderate PLUS" (the real moderate profile) implants or to high profile implants can correct rippling.

3)  Do you have textured implants?  These also increase rippling, and I would suggest switching to smooth-walled implants.


George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Fat grafting works well for rippling

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Thank you for the question. Fat grafting is an excellent technique for correcting the appearance of rippling it also improves the quality of the skin. Best of luck..

Dana Khuthaila, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 77 reviews

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