During the preoperative evaluation for breast augmentation, the breast "pinch test" is used by the plastic surgeon. This determines the adequacy of the soft tissue coverage over the proposed breast implant. With adequate "pinch," the implant will be sufficiently hidden by the overlying breast gland. When soft tissue is lacking (thin, muscular build), a submuscular silicone implant is advisable. While implant visibility is most common with subglandular implant placement and the use of saline implants, implant rippling can also be seen in submuscular placement and silicone implants. This is deemed a "soft tissue failure." Oftentimes this occurs because of over-augmentation: large implants that are being pulled downwards by the force of gravity will tend toward rippling. There are several surgical options to treat implant visibility, but weight gain may help provide more soft tissue coverage. The surgical options include composite breast augmentation (fat grafting to provide coverage) and the use of acellular dermal matricies (ADM, alloderm) to cover the implant. Both of these options are suboptimal for a variety of reasons. The most conservative option is often to downsize the breast implants and perform a breast lift, if needed, to fill out the soft tissue envelope.