What is the Chance of Rippling in Saline Implants? I Can't Afford Silicone. (photo)

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 implantsLarge implantsThin patients with low BMIImplants placed above the musclePrior history of ripplingFactors which are less likely to have rippling include:Heavier and larger breasted womenUsing a highly cohesive form-stabile silicone implants (gummy bear)Smooth implantsSmaller implantsSubmuscular placementOnce 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.#rippling#breastaugmentation

The thickness of your skin envelope and the amount of natural breast tissue will have the greatest impact on whether or not you have problems with rippling. Silicone implants certainly would lower that risk. The gel implants should only cost about $1000 more than the saline. Textured saline implants also have less rippling. They are not my usual choice for my patients, but certainly are an option. 

Nobody can give you an exact percentage of rippling in saline implants because there are many variables which effect this. You are better suited for silicone implants because you are thin and have small breasts. However, as you discovered they are more expensive. You can try saline and probably you will not have rippling. If you do, you can have new silicone implants placed under local anesthesia when you can afford them.

Thank you for your question and appropriate picture. The main advantage of silicone implants are the feel and decreased chance of rippling compared to saline implants. Having said that, if you don't plan on being much larger say full B cup, then the ratio of your breast tissue to implant is still favorable and you'll have a great result in terms of look and feel. You should discuss this with your surgeon again and weigh the risks and benefits. In terms of costs it may be worthwhile to spend more on silicone implants. In my practice, non anatomical silicone breast implants are ~1k more for the cost of the implants. Best of luck. 

You are thin and with little breast tissue of your own, so the likelihood of visible or palpable rippling with saline implants is relatively high, even with submuscular placement, which is certainly recommended. No one can give you an "exact" percentage, but I can confidently assert that rippling is ALWAYS more common with saline implants, and that silicone implants RARELY have rippling.

Silicone cohesive gel implants are so superior in "feel," natural softness, and homogeneity with breast tissue that (with my encouragement) over 98% of my patients choose silicone gel implants rather than saline. (Our cost for silicone breast augmentation is just under $6000; saline breast augmentation is $5400, so $2K difference seems high, even by New Jersey standards!) Every one of my office staff who previously had saline breast implants has undergone switch to silicone. There's a reason for this, especially since they see all patients with both kinds of implants and really end up knowing which are "best." With all issues, not just rippling!

Don't get me wrong; for 15 years (during the FDA restrictions between 1991 and 2006) we also used (mostly) saline breast implants and had many happy and satisfied patients. But those who had a higher likelihood of dissatisfaction were similar to your anatomy, and we have even more satisfied patients now that we utilize predominantly the newest generation of cohesive silicone gel implants! Honest.

If you "can't afford" silicone implants, either wait and save up for silicone, or fly to Minneapolis for a less costly operation (with the right implants). I'll bet you can pay for the flight and hotel, as well as the surgery, for less than you are paying now!

Going ahead with saline may end up being the costliest mistake you make, especially if you have to have another operation to place the silicone implants you "should have had" in the first place. Consider this carefully.  Best wishes! Dr. Tholen

Thank you for your question. I am sorry that you have concerns re rippling with saline implants. Any implant may ripple, however the firmer the implant then the less it will ripple. You will need to speak to your PS and discuss the risk/bebefit ratio. If there is cost difference then shop around!

Wrinkles or folds may occur in an implant, especially around the bottom or sides. When these folds or wrinkles are visible through the skin, it is known as rippling.
Through common sense reasoning, the less soft tissue that you have covering the implant, the more likely it is that it will be visible through your skin.
Therefore, risk factors for rippling related to coverage of the implant are: low body mass index BMI (how thin you are), less breast tissue, and placing the implant over the muscle. (Many doctors now only place implants below the muscle for many reasons, eliminating this factor.)
Saline implants are more likely to ripple. So if a patient is very thin and has little breast tissue, I would encourage silicone implants. If she has sufficient tissue to cover the implant, saline remains a viable option for her.
I hope that answers your question on rippling. It’s great that you’re doing this research. I always say that the best patients are informed patients.
You might also want to research your options for breast implants. Choosing the right implant is the number one concern among women considering breast augmentation. Did you know, there’s actually a way to select a implant shape, size, and profile that is perfect for you?
A term that I use with my patients for the perfect implant is the “Pony Implant”.
So what do I mean by “perfect”? Well, a Pony Implant has three qualities to it. First, the implant meets your beauty goals. For example, you want to your breasts to look fuller while still appearing natural.
Second, when you chose your Pony Implant, you walk out of your consultation 100% confident that you’ve chosen the right shape and size for you. In other words, you won’t be second guessing your decision, and you won’t be afraid of having gone too big or too small.
And third, after your procedure, you are thrilled with your results, and say, "I’m so happy. This is exactly what I wanted!"
That’s the Pony Implant. And the great news is that there is a simple process to go about finding yours.
This issue of selecting the right implant is so important when it comes to patient satisfaction or dissatisfaction that, again, I really encourage you to learn more about it.
Thank you for reading and best of luck on your journey!

While I don't guarantee a cup size, I do guarantee that whatever volume a woman chooses using prefilled sizers we will use.  Did you "size" with your plastic surgeon?

If you have chosen to use 200-300 ml volume implants, your results may be similar with gel and saline, and you won't need to worry about paying for the recommended post gel implant MRI studies every 2-3 years to rule our a silent rupture!  The MRI studies are not needed with saline filled implants.

If you choose a larger implant volume- say a fill of  300 ml on up, then a textured gel implant may provide you with less rippling than saline.  But all implants- saline and gel- can show rippling- particularly if you go too large.    The new "form stable" or "gummy bear" gel filled implants have less ripple potential, but when placed in someone like you with very little overlying soft tissue or skin coverage, the tradeoff is a firmer breast- less rippling but increased firmness!

Decisions, Decisions!  Best to speak a bit more with your plastic surgeon about all options. Don't skimp on the cost if gel would give you the best result.  If you don't fees comfortable with the answers you get, consider a second opinion with another surgeon before you proceed- choose a member of the Aesthetic Society- that groupo of board certified plastic surgeons who specialize in and  have extra training and experience in cosmetic surgery and cosmetic medicine.

 

The chances of rippling with a saline implant greatly depends on how much of your own breast tissue you start off with and your skin quality.  Silicone does have a smaller chance of rippling and I typically recommend silicone to patients of your size.  Perhaps interview a couple other surgeons so you can find one who makes you feel as comfortable as you should feel when making this decision.  My cost for silicone gel implants is $1000 more than saline.  ac

The rippling seen in saline implants is related to the amount of overlying tissue versus the fill of the implant

The overlying tissue can be thickened with fat injections

The fill volume can be  adjusted  after surgery with the use  of the adjustable saline implant