Breast Implant Revision- Overs to Unders for Rippling? (photo)

Two years ago I had 410cc textured High Profile, silicone cohesive gels placed over the muscle. It took me from a 34b to 34D.I was told I needed to go over the muscle to correct slight sagging (which I don't think I had much of). Since I had the surgery I have experienced some rippling of my left breast and some more sagging. Would I need a breast lift? If so which lift? Different profile implants or go bigger? Go under the muscle?Internal Sutures?What are the recommendations for my revision?

Doctor Answers 10

Place Implants Under

Thank you for your photographs.  Placement of the implants beneath the muscle will help the wrinkling.  A lift might be needed but this is best determined by an examination.

Dr. ES

Rippling of implants

Upper pole rippling can be caused by a thin soft tissue coverage. Placing  the implants under the muscle adds another layer of support and can help.  As for lifting, it depends upon how you look in person. Tough to say from photos.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Correction of rippling and sagging with 410 implants

First the disclaimer: No one can give you specific advice online. In general, here are the issues: Placing implants over the muscle does not correct sagging, only makes it worse after a while as you report. Second, the types of rippling shown in the pictures, over the upper part, are called traction ripples. Since the muscle covers only the upper part of the implant, it can help to put the implants under. However traction ripples are also helped by supporting the implant from below, and there are various ways of doing that. Third, if you had some sagging before implants then some sort of lift needs to be part of the plan.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 53 reviews


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.


Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews

Implant rippling

I would recommend placing new silicone implants (smooth wall or form stable) under the muscle. This should correct the rippling. For rippling in other areas, allograft or suturing might be needed. I think the biggest issue here is the above muscle placement, which has a higher incidence of rippling.

Kurtis Martin, MD
Cincinnati Plastic Surgeon
4.8 out of 5 stars 74 reviews

Best Breast Revisionary Operation for Me?

Thank you for the question and pictures.  As you know, it is difficult to give you precise advice online, but given your main concern of breast implant rippling, replacing breast implants in the sub muscular pocket will certainly be of benefit to you. This procedure along with the use of allograft and/or internal sutures (capsulorraphy) will likely significantly improve the outcome of the procedure performed.  Ultimately, you will benefit from in-person consultation with well experienced plastic surgeons who can demonstrate significant experience with revisionary breast surgery. You may find the attached link helpful to you as you learn more about options available. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,498 reviews

Texturized implants have a higher rate of visible and palpable rippling.

Probably the best solution would be to swap out to smooth walled implants. Silicone gel is less likely to produce contour irregularities and saline. Texturized implants were introduced to decrease capsular contracture which they don't.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 36 reviews

Breast Implant Revision- Overs to Unders for Rippling?

In my opinion based ONLY on the posted photos you have an acceptable though could be improved result. Best to obtain IN PERSON evaluations from boarded PSs in your city. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Rippling of implants

One of the most important things a breast augmentation patient needs to understand is that breast augmentation is an inherently imperfect operation. There are many things that can cause dissatisfaction that are not complications per se. Whether is it is rippling, some degree of firmness, roundness, excessive fixation or mobility, they are what make breast augmentation inherently unnatural. This does not mean you cannot have very natural looking, or natural feeling, excellent and desirable results. It just means that you have to prioritize these imperfections and decide on which ones you can live with. Otherwise, it is possible to get caught in 'chasing the imperfections' where correction of one imperfection leads to another undesirable imperfection. In general, the more disproportionate the implant is to your natural breasts, the more these imperfections will appear. I think that is the fundamental situation with your case.

Robin T.W. Yuan, M.D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Breast Implant Revision- Overs to Unders for Rippling? (photo)

Your questions and photos are excellent, but specific.  There is also important information omitted, such as are you happy with areola size?  What is your tolerance for larger implants?  What is your scar tolerance?  Realself is an excellent online forum for exchange of knowledge and general advice, but in my opinion, the specific questions you ask are best answered in personal consultation.  Recommendations for treatment should only be made in the context of your personal preferences, lifestyle, findings on physical exam, etc., information best discussed in the office of your surgeon.

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 47 reviews

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.