I had saline implants a few years ago. I can feel and see the ripples in my breast. Would silicone implants be a better choice?

I want to go with a larger implant but should I switch out my saline implant to silicone because I am going larger? I have 425cc wear a size c and D bras. I want to be able to wear full DD bra so how many cc will it take to fit DD bra size? Do silicone implants have ripples in it? I have saline and I can feel ripples in my implants. I don't like the feeling of it and I want to know from experts do silicone feel the same way?

Doctor Answers 11

In person exam required

You need to be evaluated in person so the anatomy and available operations can be presented to you. Then, you can consider what your goals and expectations are. When the surgeon and you agree on a plan that takes into consideration your present state, what you are trying to achieve, what is possible, and what will make you happy, then you can proceed.

Rippling with saline implants

Silicone implants, particularly the newer devices will have less rippling than saline ones. This has been found in several studies. This does not mean that the newer silicone implant options can't cause rippling - because they can - but it may be less severe or frequent. Other techniques like ADMs and fat grafts may also serve as adjuncts to reduce rippling depending on your situation.

I had saline implants a few years ago. I can feel and see the ripples in my breast. Would silicone implants be a better choice?

Silicone gel implants feel more natural and tend to have less rippling but if you go large, the gel implants can ripple also. The exact amount of cc's needed to go to a DD cup is hard to determine as it depends on your chest circumference (34DD vs 36DD vs 38DD, etc).

See link below for examples. 

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 65 reviews

Would silicone implants be a better choice?

Silicone implants do have less of a tendency to have a ripple or fold and might be the better choice, especially for a larger implant. The ripple or "show through" can depend on the implant placement and breast tissue to cover as well. Photos of just how you wish to look will be a guide to the size to consider.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.1 out of 5 stars 40 reviews

Silicone implants wrinkle and ripple less than saline implants

Even though silicone implants can and do wrinkle and ripple, the likelihood is much less than saline implants.  Implants with smooth outer shells wrinkle less than textured shell implants.  High profile implants also wrinkle less than moderate profile implants, so when choosing new implants consider also switching to a high profile smooth silicone implant.

From 1992 to 2006 silicone implants were placed on a moratorium by the FDA in the United States.  During this 14 year span only saline implants were available for use.  The saline implants are fine, but they do wrinkle and ripple more and do not feel as natural as the new silicone implants, they feel like water balloons (they basically are). The new silicone implants have been on the market for 10 years now and are very reliable with a low rupture rate and a nice natural feel.   It is very common to undergo remove and replace procedures switching from saline to silicone.  The recovery is much quicker than the original procedure and there is much less pain and swelling because the original stretching has already been performed.  Silicone implants come with a lifetime warranty, the implant company will replace BOTH implants if either break or rupture for any reason and pay for the cost of the surgery.

As for size selection, most women like to go around 50% greater than the original implant size to see a noticeable difference in size.  Please consult with a Board Certified Plastic Surgeon who performs breast enhancement surgery frequently to maximize the best possible result.

Good Luck!

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 73 reviews

Wrinkles in implant

 While generally speaking, gel implants will wrangle less than saline implants, there are a few other considerations you might want to know.Both silicone filled and saline filled breast implants are approved for use in the US by the FDA. Both are safe. Breast implants in general have had multiple studies looking at the incidence of collagen vascular disease in patients both with and without implants. There is now definitive evidence that silicone gel implants do not increase a woman's risk for any rheumatologic condition or any set of symptoms that may represent a new disease. Interestingly, the shell of both implants is made of a rubberized silicone. Therefore, what's actually touching the patient inside the pocket is silicone in both a saline and silicone breast implant. There are a few differences in saline and silicone implants that one should consider before choosing each. Saline implants, because they are filled with water, if properly filled, will collapse in the upper portion of the implant as the water reaches a meniscus and lays flat. Saline implants also have a more palpable edge that looks like a wave that you can feel and sometimes see as a wrinkle. When saline implants are grossly overfilled, beyond the manufacturers stated range, these wrinkles can be alleviated by the overfilled implant. These implants may then feel very firm. Because saline implants are two convex discs essentially glued together, as they are filled, the transition from the back of the implant to its front can be very abrupt leading to a much more visible edge. This will make the breast seem very round in patients with very little overlying tissue. In my mind, there are a few advantages of saline implants. Saline implants cost less and because they come with no fluid in them, can be placed through remote access ports like the bellybutton or underarm. Silicone gel implants do not wrinkle as much, feel more breast- like, look better under the breast with less harsh of an edge and therefore less visible than saline implants. Because the gel is connected all the way through to the top of the implant, even in the upright position the upper pole of the breast does not completely collapse. I believe this is better in situations where after pregnancy or weight loss, the patient needs some fullness added to the upper pole of her breast. There's also a difference in how long these implants may last. In my experience, saline implants have a 10 year break rate that somewhere in the low teens and silicone gel implants are somewhere below 5%. In today's modern cosmetic breast practice, where Vectra 3-D imaging is commonly done, I don't think it's an advantage of saline implants that you can add some saline to them intraoperatively to make better symmetry. Using the Vectra 3-D imaging platform, different sizes and shapes and volumes of implants can be placed on a 3-D image of the patient to decide which implants make for the best symmetry and therefore nothing needs to be changed in the operating room. One of the criticisms of silicone gel implants in the past was that the gel with a broken implant could escape into the breast tissue and end up causing systemic illnesses or get into the lymph nodes. Modern silicone gel implants are made with a gel diffusion barrier on the inside such that the small particles of silicone cannot leech through the shell. Also, the gel itself is highly cohesive or sticky taking on more of the consistency of a gummy bear candy than of a liquid. In fact, if the implant is cut in half, the gel will only extrude from the remaining implant if squeezed and then return to the shell when the pressure is let go. Therefore, in the event of a broken silicone gel implant, the gel will be contained mostly inside of the shell of the implant. In my cosmetic breast practice, for the last 13 years or so, I have used mostly silicone gel implants. Hope this information is helpful.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

Dr Kayser

Thank you for your question. Your concerns are not uncommon as saline implants tend to have more inherent rippling because of their fill. Silicone implants tend to have less rippling and are even less problematic with the more form stable cohesive devices. Secondly, the placement of the implant can also have an effect on visible irregularities especially if it's placed above the muscle. Finally, as an implant is used it necessarily stretches the skin, and like a Chinese finger trap, when this occurs thinning also occurs which results in more visible and palpable irregularities. A silicone implant will improve the problem, however, this will not be eliminated. The fact that you want to increase your volume is a concern as this will necessarily result in even greater irregularities due to further stretch of the skin and thinning.

An option to consider would be to place fat grafts, transferred from one part of the body to the breast in order to thicken the soft tissue envelope and help decrease some of the irregularities that you have concerns with. In any case I would recommend a consultation with a board-certified plastic surgeon who is experienced in all forms of breast surgery. I hope this helps and have a wonderful day. Dr. Kayser - Detroit

Melek Kayser, MD
Detroit Plastic Surgeon
4.9 out of 5 stars 31 reviews

Rippling after saline breast implants.

Rippling is a very common occurrence after placement of saline implants.  Over time breast tissue can thin, which makes the implants more obvious.  Silicone implants can greatly improved the rippling.  Though in  extremely thin patients, rippling may still be evident despite using silicone implants.  You did not state whether your implants were above or below the muscle.  If they are above the muscle, I would recommend placing them below the muscle.  This could improve rippling if it is in the upper portion of her breast.  Utilizing a round smooth gel implant would yield a great result.  The use of a shaped implant would improve the rippling to an even greater extent.

Joseph C. Berardi, MD
Scottsdale Plastic Surgeon
4.6 out of 5 stars 13 reviews

I had saline implants a few years ago. I can feel and see the ripples in my breast. Would silicone implants be a better choice?

I am sorry to hear about your concerns after breast surgery. Although I cannot provide you with specific advice, some general thoughts may be helpful to you. You may also find the attached link, dedicated to revisionary breast surgery concerns, helpful to you as you learn more.

Unfortunately, ALL types of breast implants can be associated with rippling/palpability. 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 extension weight any rippling/palpability of the implants. Deflation of the implants will also increase the rippling/palpability of the implants.
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), and/or the use of acellular dermal matrix to provide an additional layer of tissue between the implant and the patient's skin.
In-person consultation with board-certified plastic surgeons who can demonstrate significant experience helping patients with this type of revisionary breast surgery will be your next best step. Best wishes.

I had saline implants a few years ago. I can feel and see the ripples in my breast. Would silicone implants be a better choice?

You may well have a number of options.  Without photos it is difficult to answer your question.  However, if rippling is a major issue, you should consider both round silicone gel and the newer shaped (Gummy Bear"\) implants.  They may well help with the rippling and can improve the shape and feel of the breasts in many cases.

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.