I have deep ripples when I bend over, in cleavage area when standing up right. 4 mo post op 385 HP Gel under muscle. (photos)

I had no breast tissue before surgery due to breast feeding. My question is why didn't my surgeon tell me I was a high risk for rippling, I would have paid the extra to prevent this my first surgery. And now what are my options? I have an appointment tomorrow but I would like your expert opinions also

Doctor Answers 4


the treatment of rippling is either fat grafting or placement of ADM. I would discuss this with your surgeon. the other remedy is weight gain , but I have never seen anybody do this yet.

Newark Plastic Surgeon
4.7 out of 5 stars 64 reviews


Hello,The only way to have minimized this problem would have been to pay attention to the biodimensional measurements and used an implant based on those measurements. 385 cc implant was far too large for your breasts, and your photos depict how your current implant extends past the bottom and sides of your natural breast tissue. The easiest thing to do is change implants for smaller, form stable devices like the Natrelle 410 or Mentor Memory shape, and tighten the capsule to close off the areas that were opened in order to fit your current implant. The other alternative is fat grafting, but that is not as simple, easy, or reliable as it sounds. Go visit a few ABPS certified/ASAPS member surgeons expert in revision breast surgery.Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 89 reviews


Thank you for your question. Unfortunately, even when placing cohesive silicone gel implants under the muscle there is a risk of seeing/feeling the implant where kin and tissue is the thinnest- typically at the bottom and sides of the breast. When you lean over an skin relaxes further, gravity can cause the implant to fold temporarily. The only way to further camouflage your implants might be to gain weight or fat grafting. You could discuss these concerns and options with your Plastic Surgeon when you see them next.
All the  best

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

Fixing implant rippling

I am sorry that you were unaware of your risk for rippling. It can definitely be difficult when you spend so much money and do not get what you want.

Rippling, or implant wrinkling which is visible through the skin is common in patients who are very skinny and have very little fat or soft-tissue (breast tissue, fat tissue, and skin) to hide the implant. I believe the latter applies to you as you said you had very little breast tissue before surgery.

Weight loss definitely worsens the situation, and unfortunately, rippling also worsens with time as the implant puts pressure on the breast tissue and thins the tissue to create deformities in the ribs causing them to hold a different position in the chest.

Let me discuss the steps that could be taken to minimize rippling.
  • If someone has textured implants, have it changed for a smooth surface
  • If someone has saline implants, have it changed for a silicone implant
  • If someone has large implants, have it changed for moderate sized implants so that breasts can better conceal the implant
  • If 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 visible
    • This 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.
In your case, you have silicone gel implants placed behind the muscle so the best steps have been taken. However, having the implants replaced for smaller ones may help.

I am unsure how your implant size was selected, but a board-certified surgeon will always determine a suitable range for the implant volume after conducting some breast measurements. Measurements such as breast base width, the amount of breast skin stretch, nipple to breast fold distance under maximal stretch, skin quality, chest wall asymmetries, etc. has to be considered. This allows the implant size to be tailored to your breast characteristics and breast boundaries.

So getting a smaller implants in addition to have fat grafting to cover areas where implant rippling is visible will definitely help.

Hope this helps

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 457 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.