Is It Normal for Silicone Implants to Ripple? (photo)

Question

I have 600cc high profile Natrelle silicone gel breast implants on top of the muscle, and when the swelling went down these ripples appeared. If I had them replaced with a smaller implant under the muscle would I still have the ripples? I could tolerate side and/or bottom ripples, but ripples in the cleavage area are unacceptable to me. More ripples can be felt than can be seen, and I am afraid they are just going to get worse.

Larry S. Nichter, MD, MS, FACS · Answer

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

Mark A. Schusterman, MD, FACS · Answer

Although gel tends to ripple less than saline it can still occur. They key to natural implants is to put them as deep in the body as possible. The only solution for your problem is fat grafting or converting to submuscular placement or both.

Hilton Becker, MD · Answer

Both saline and silicone gel implants can ripple

	It is less common for silicone gel implants to ripple

	The factors thet increase rippling with gel implants include:

	Surface texturing

	High profile

	low profile

	Thin overlying tissues

	So the teratment will depend on the above

	The implants may need to be changed .If the tissues are thin they can be thickened with fat injections beneath the skin  or the addition of mesh to the capsule

Darryl J. Blinski, MD · Answer

Sorry for the "rippling" of the silicone implants as demonstrated in your photo posted. Two issues are present, the inherent risk in the implant to "ripple" as described in the manufacturer's literature. And the implant placement above the muscle. So I bet you can see where I'm going! The ways to correct are either live with this, change pocket location to below muscle, or try fat grafting along the rill pled areas - risky for rupture or puncture. Hope that helps. Great question Follow up would be nice.

Steven Wallach, MD · Answer

Rippling occurs because the tissues are very thin. An implant under the muscle will have better coerage superiorly but still may develop ripping. Sometimes strattice or even fat injections can help minimze this.

Peter E. Johnson, MD · Answer

The amount of ripple and show through for any given breast implant depends on the amount of soft tissue to cover and hide. Even a lower profile implant can ripple. One solution is a more highly cohesive breast implant which will hold its shape and ripple less. The new gummy bear implants from Sientra are widely available and could reduce your ripple.

Leonard T. Yu, MD · Answer

I would agree with the information proved previously and also add that rippling in the cleavage area can also be due to textured surface implants and an implant volume that is too large for your anatomy. Another option for small areas of rippling may be fat grafting to add more soft tissue coverage, but this would not be my initial recommendation for your situation.

Tom J. Pousti, MD · Answer

Thank you for the question  and pictures.

	Palpability  and rippling of breast implants may be related to several factors. 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 accentuate any rippling/palpability  of the implants.  Deflation of   saline implants will also increase the rippling/palpability of the implants.

	In your case, it is very likely that revisionary surgery may be helpful to you. This operation may involve replacing the breast implants into the sub muscular (dual plane) position and/or the use of allograft  material (if necessary). Of course, precise advice will necessitate direct examination and a full communication of your goals.

	Best wishes.

Is It Normal for Silicone Implants to Ripple? (photo)

Answers (8)

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