What is the best type of implant to avoid rippling?

Dear JulietDylan,Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. The two main types of implants are silicone and saline. The shell of the implants can be either textured (which reduces capsular contracture) or smooth. A textured implant sometimes requires a larger incision. The shape of the implant can be either round or tear drop shaped (gummy bear). Both have their advantages and disadvantages.
The different types of implant offer different pros and cons. For instance, the pros of silicone implants are that they look and feel more natural and ripple less.
On the other hand, the pros of saline implants are that they do not require as large of an incision as silicone, less expensive, they have less incidence of capsular contracture (scarring around the implant), one can tell immediately if there is a rupture, the size can be slightly adjusted, and they can be used for women less than 22 years of age.When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hi JVisible and/or palpable implant rippling is a potential problem with any implant, placed above or below the muscle.  People most likely to get ripples are people with the least amount of covering over the implant (thin skin, minimum breast tissue, minimal muscle).  The best implant to minimize ripples would be a smooth, round, silicone gel filled implant placed under the muscle.  Larger implants of the same series (e.g., SRM, etc) increase in diameter as the size goes up, so a larger implant may produce more ripples.Hope this helps.with best regards,Scott E. Kasden, M.D.

That is an excellent question about a very common problem. I have seen a number of patients with this issue I my community. Keep in mind that all implants have advantages and disadvantages. The reason you are having rippling is that the amount of tissue covering the implant is inadequate. If you decide to increase the size of your current implant, then your tissues will be spread even thinner which may increase your rippling. You have several options though. If you use a more cohesive implant (SSM or SCM), then the rippling may improve because the implant will maintain its shape better.  However, the implant will have a firmer feel and the edges of the implant may be more obvious to touch. One additional option you have is converting to a composite breast augmentation which includes using an implant plus increasing your tissue coverage through fat grafting or transfer. It works really well for patients in your situation. Consult with your plastic surgeon to see if this is an option for you. 
I hope this helps and take care. 

Hi,
Rippling has a lot to do with how much of "you" there is to cover the implants.  The more there is of you to cover the implant the less chance you will see the rippling.  The more cohesive implants will tend to not have as much rippling as they don't fold in on themselves as much, however, the implants are harder to the touch.  Going will a larger implant will thin out your "natural you" over time even more and I would anticipate you will have a possibility of increased rippling. This will be something you want to think about. 
I hope this helps.
Take care - Dr. Bekanich

The implant rippling is a result of not having enough soft tissue cover or fat over the implants. Fat grafting is a good option here. My preferred implants are the SIENTRA brand. I think they have the least rippling and look great

Hi and thanks for your question!  Rippling can have many causes but it seems like your thin tissue is probably the culprit.  I use Natrelle SRM implants a lot and have been really happy with the results and lack of rippling.  If you have rippling with SRM implants, I would recommend going to a SCM as it is firmer and will give you the least risk of ripping.  The downside is that it is a stiffer implant.  It's not nearly as hard as an overfilled saline implant but it's stiffer than the SRM and SSMs.  Good luck!

Hi and thanks for your question-I would suggest that you go back to discuss your concerns with your original surgeon. S/he will want you to be happy and will likely want to help you with any revision you might consider. In general, larger implants are going to be heavier and may stretch out your tissue even more. Because of this you may have even less tissue coverage over a larger implant, which may lead to being able to feel the edges even more. Going larger may give you the volume you're looking for, but may thin your own tissue due to implant weight.The SSM and SCM implants are a bit firmer; sometimes the SCM is too firm for cosmetic augmentation. It's difficult to tell if changing the implant will help your rippling without an in-person exam. Ask your surgeon if s/he can let you feel samples of each type of implant before you decide.I hope that helps-

Thank you for the question. Online consultants will not be able to help you with specific advice but some general thoughts may be helpful to you.

Generally speaking, palpability and rippling of breast implants  may be related to several factors (besides the type or size of breast implant used). These include the amount of soft tissue and breast tissue coverage over the breast implants, the position of the breast implants (submuscular versus sub glandular), the type of implants (saline versus silicone), and the degree of overfilling of saline filled implants. Generally, weight loss will extension weight any rippling/palpability of the implants. Sometimes correction of the rippling may involve further surgery including implant pocket exchange if possible (sub glandular to submuscular), implant exchange if possible (saline to silicone), capsulorraphy (adjustment of the surrounding breast implant capsules to prevent displacement) and/or the use of allograft (acellular dermal matrix) to provide an additional layer of tissue between the implant and the patient's skin.  
Also, generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of know words such as “natural” or "C or D cup” etc means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.

3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers. I hope this (and the attached link/video, dedicated to breast augmentation surgery concerns) helps. 
Best wishes for an outcome that you will be very pleased with.

Dear JulietDylan,Hello and thank you for your excellent question. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!

Best,

Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Texas “Top Doc” 2017, 2018

RealSelf100

America’s Top Plastic Surgeons, Consumer’s Research Council, 2010 – 2018

BeautyAdvisor Top Contributor