Will Rippling Be Fixed with Larger Implants?

To help improve rippling we have many options, changing the implant to below the muscle, switching to a form stable textured device, fat grafting on top of the implant, as well as covering with a skin substitute

A larger implant will cause more risk for rippling. Procedures which can help rippling are moving the implant below the muscle, grafting a material inside the breast (dermal matrix), changing the implant to a "form stable" implant, and sometimes fat grafting.It would help to discuss and evaluate your options in person.

Going with a bigger implant is not the answer.  Most implant have rippling and it's just a matter of how much coverage you have to cover up the implant imperfections.  Going under the muscle makes things better (muscle is an extra layer on top of the implant thus making ripples less visible).  Using a smooth implant is better (because a textured implant sticks to the overlying tissues and is more likely to show rippling.  A fuller fill (whether saline or silicone) means less rippling.  For saline implants surgeons often overfill them to minimize rippling.  Now both Mentor and Allergan have silicone implants that are filled fuller than previous silicone implants thus minimizing rippling.  And finally, tear drop implants (anatomic/form stable implants) have the most cohesive type of silicone which maintains it's shape the best and thus ripples the least.  However, in my experience, tear drop implants are often 'too natural' for most breast augmentation patients as they lack upper pole fullness.  I no longer recommend these implants for cosmetic purposes.

Without examining you, as a general statement I'll say Mentor Cohesive II and Allergan Inspira True Form 2 silicone implants, placed under the muscle, are you best bet to fight rippling.

Martin Jugenburg, MD, FRCSC
Toronto Cosmetic Surgery Institute

Silicone implants tend to ripple less than saline implants.  Textured implants tend to ripple more than smooth implants.  Implants above the muscle tend to ripple more than implants under the muscle.  Therefore, I would definitely go below the muscle with smooth silicone implants, and if the rippling is at the bottom of your breasts, then placement of an acellular dermal matrix (ADM) should eliminate the rippling. 

A larger implant unfortunately can lead to traction rippling, and therefore I think placement of a larger implant would not be a good idea. 

Dealing with rippling can be a difficult issue.  Silicone gel implants (especially form stable if available) are a great first step in decreasing visible rippling.  Another option is placing the implant in a different pocket.  Often placing in a submuscular position will help due to muscle coverage.  If the rippling still occurs despite muscle coverage or occurs in an area where muscle coverage is not possible, acelluar dermal matrices (ADMs) are a very good option.  Several options of ADMs exist and some are very thick.  The downside is the expense of these materials.  Sometimes increasing the size of the implant can help with rippling.  But there is a significant drawback with going to larger implants.  The larger implant will stretch your tissues further and eventually thin them more.  This will lead to possible visible rippling again in the future as well as other problems such as ptosis (drooping) of the breasts.