Is There Anything That Can Be Done to Reduce Rippling After Breast Reconstruction Surgery?

I am 52 and have had a bi-lateral mastectomy followed by silicon breast implants. I notice rippling at the top of my breast when I lean over. I will have nipples added in a couple of months. Is there anything that can be done during this upcoming surgery that can help cover up the ripples?

Doctor Answers 7


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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 implants
  • Large implants
  • Thin patients with low BMI
  • Implants placed above the muscle
  • Prior history of rippling
Factors which are less likely to have rippling include:
  • Heavier and larger breasted women
  • Using a highly cohesive form-stabile silicone implants (gummy bear)
  • Smooth implants
  • Smaller implants
  • Submuscular placement
Once 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 after mastectomy reconstruction

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Thank you for your question. Rippling can be seen when the surface of an implant shadows through the tissue, often found where the breast tissue coverage is thin as can happen after breast reconstruction using implants after a mastectomy is performed. One approach would be to add some thickness to the breast tissue. This can be done by fat grafting where fat is carefully layered between the skin and the implant. Another is to add a dermal matrix sheet between the breast and the implant where the rippling is visible to blunt the impression of the implant on the overlying skin.  You can also change the implant for one that may be less prone to rippling such as a shaped implant.

Further, if you notice the rippling soon after surgery, I often recommend waiting until around the six month mark as your breasts may continue to change during that recovery period. I would visit your plastic surgeon to discuss your options in more detail.

Rippling of Implant after Mastectomy Reconstruction

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The problem here is that you have thin mastectomy skin flaps and likely muscle covering your implants.  This rippling can be addressed by placing a larger silicone implant to fit more snug into the pocket; or tighening the skin envelope, or utilziing dermal matix products to create an internal bra for your implant to fill the empty space causing the rippling, or considering the form-stable cohesive gel implants (Which only a few plastic surgeons have access as part of a national investigation study).   Another option would be to consider autologous tissue only reconstruction if this issue really is bothering you.   Rippling is sometimes a limitation of implant based mastectomy reconstruction.  Talk to you plastic surgeon to learn more about your options.

Breast Reconstruction

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The most important thing to do now is to have another consultation with your plastic surgeon. The important question is DO YOU HAVE ENOUGH COVERAGE OF THE IMPLANT? Or is the skin subcutaneous tissue is too thin

Alloderm is used to hide the rippling, but I am concerned because you have a silicone implant and still showing some rippling in the superior aspect of the implant . The superior aspect of the implant, after reconstruction, is usually coverd by the pectoralis muscle, and shoul not have rippling. So, if that is the case is the addition of a thin coverage like alloderm going to be enough to hide the rippling?

or you need more coverage, like a Latismus dorsi flap. These discussions must be made before the nipple areola reconstruction.

Samir Shureih, MD
Baltimore Plastic Surgeon

Ripling implants after mastectomy

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Rippling happens in both mastectomy patients and thin skinned breast augmentation patients.  Allderm may be the answer to camouflage the rippling.

Correction of rippling after Breast Reconstrction

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All breast implants ripple and Saline breast implants ripple more than silicone gel implants. This is the major fact why implants are placed UNDER the muscle. The idea is for the muscle to add volume and coverage hiding the ripples.

You should ask your Plastic surgeons about increasing the coverage of the implants. IF the implants are over the muscle, putting them under the muscle will greatly reduce the ripples, otherwise using the back muscle to add further cover or placing a cover of AlloDerm may thicken the cover and hide the ripples.

Peter A. Aldea, MD
Memphis Plastic Surgeon

Rippling implants

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Ripples are more evident when the implants are soft so to some extent you should be happy they are not hard. Implant reconstruction is imperfect and rippling is inevitable. What can reduce it is to hide it behind thicker tissue. Alloderm can improve this to some degree. Some surgeons use fat injections. If you are severely thin, a latissimus flap is available. A larger implant may increase firmness and decrease rippling a bit. It's all a trade-off.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

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.