Ripples After Breast Revision?

I recently had a breast revision for grade 4 capsular contracture. This time in surgery I opted to go with smaller breast implants. I'm now at 250cc on each side however now I have ripples in the cleavage area. I never had ripples before when I was 300cc. How could this be?

Doctor Answers 7

Rippling implants

Rippling in the cleavage can occur if the implants are above the muscle, which is why I prefer to place them under the muscle.  If they are already under the muscle, it can occur if the muscle has been released too much.

San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Ripples After Breast Revision?

I am sorry to hear about the problems you have experienced after breast augmentation and revisionary breast surgery. Although your plastic surgeon will be your best resource when it comes to  precise/relevant answers to your questions, it is very likely that you are feeling/seeing the breast implants more  now because the breast implant capsule tissue was removed during the recent procedure.

 It is possible, that as the breast implant capsule develops again ( or if you were to gain some weight), that the breast implant will  become less palpable/visible.

 Otherwise, at some point, you may benefit from the use of acellular dermal matrix as an additional layer between the breast implants and your skin.

 You may find attached link helpful to you as you learn more about this option.

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,485 reviews

Issues after capsulectomy for contracture

For a grade 4 contracture you would have had a procedure called capsulectomy, in which the entire scar capsule is removed. This removes some of the tissue that also helps conceal the implants and so rippling would be more visible, especially with smaller implants and if they are above the muscle. If they are already under, then reinforcing the pocket with Strattice would help and this also provides some protection against recurrence of the contracture.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Ripples After Breast Revision?

Ripples would never be seen in a grade 4 capsular contracture. The contracture has the implant under such pressure you would not have the ripples. Also you now have a pocket that is slightly larger than the 300cc implant and have a 250cc implant in it so it is very easy to have ripples. You notice ripples when the covering soft tissue is thin. The saline implants ripple much worse than silicone. You don't mention which type implant you have. Since you can't realistically make your tissues thicker, you need to make talk to your surgeon about making the pocket smaller or the implant bigger, make sure you have silicone and not saline implants and make sure the implants are under and not over the muscle. The newer highly cohesive gel implants have the least rippling.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Ripples After Breast Revision?

It is hard to answer this one due to incomplete information. If your implants are not under the muscle then they should be. Your pocket might be large as well. hopefully you have silicone implants. 

Kurtis Martin, MD
Cincinnati Plastic Surgeon
4.9 out of 5 stars 72 reviews

Ripples after Breast Implant Revision for Capsular Contracture

Ripples are often the result of a less-full breast or breast implant.  Obviously, there are a lot of variables here, but the easiest way to see ripples is to take a saline breast implant and underfill it.  If the smaller implant did not fill out the pocket, you might similarly get ripples from the tissue, especially if the scar lining (capsule) was not completely removed in that area, and was not filled out by the implant.

On the other hand, removing the scar and capsule could have left the tissue in that area thinner, and thus made the implant itself more visible through the thinner tissue.

If you post some additional details, such as the type of implant (saline or silicone), the exact model (and implant fill if saline), and/or photos, it might be possible to answer a little more specifically.

James Nachbar, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 22 reviews

It is not the size of breast implants that causes rippling.


Of course I don't know what the problem is, but here are some possible solutions:

1) switch to silicone if you have saline implants.

2) switch to moderate PLUS or high profile if you have moderate profile.

3) switch to smooth walled if you have textured implants.

4) switch to under the muscle if they are over the muscle.

5) Reinforce rippled areas with Alloderm or Strattice.

Hope this helps.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

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.