Rippling and Uncomfortable Breast After Augmentation

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 implantsLarge implantsThin patients with low BMIImplants placed above the musclePrior history of ripplingFactors which are less likely to have rippling include:Heavier and larger breasted womenUsing a highly cohesive form-stabile silicone implants (gummy bear)Smooth implantsSmaller implantsSubmuscular placementOnce 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#breastaugmentation

Thank you for your question and for sharing your concerns with us. Rippling can be seen when the surface of an implant shadows through the tissue, often found where the breast tissue coverage is thin. Some implant styles are more prone such as an overfilled saline implant. Others are less prone such as a shaped silicone implant. So one approach is to change an implant to one that is less prone to rippling.I would return to your surgeon who can examine you and help to diagnose the discomfort that you are feeling.  It is hard to know whether this will resolve or remain.  If you are early in your recovery, it is more likely that some of the discomfort could be due to the healing process.  

I don't quite understand your complaints but I would consider switching to a high profile silicone breast implant or contemplate the use of fat grafts. 

Experiencing rippling and discomfort in your breasts after augmentation surgery can be concerning. Here are some potential reasons for these symptoms:
1. Implant Type: Rippling can occur more prominently with saline implants compared to silicone implants, especially if you have thin breast tissue or a small amount of breast tissue to cover the implant.
2. Implant Placement: If the implant is placed above the muscle (subglandular), it may be more prone to rippling compared to implants placed below the muscle (submuscular), as the muscle provides additional coverage.
3. Weight Loss: Significant weight loss after breast augmentation can cause the skin and breast tissue to become thinner, potentially making rippling more noticeable.
4. Capsular Contracture: This is a complication where the scar tissue around the implant tightens and squeezes the implant, causing discomfort and sometimes distortion of the breast shape.
5. Implant Size: Choosing an implant size that is too large for your natural breast tissue can increase the risk of rippling and discomfort.
6. Poor Surgical Technique: In some cases, rippling and discomfort may result from surgical errors or inadequate surgical technique.
7. Underfilling or Overfilling of Saline Implants: If saline implants are underfilled or overfilled, it can affect the appearance and feel of the breasts.
If you're experiencing these symptoms, it's important to consult with your plastic surgeon. They can evaluate your condition and recommend appropriate treatment options, which may include:
• Revision surgery to change implant size or placement.
• Treatment for capsular contracture, if present.
• Switching from saline to silicone implants.
• Fat grafting to improve breast contour and cover rippling.
• Other interventions tailored to your specific situation.
Always communicate openly with your plastic surgeon about any concerns or changes you notice in your breasts after augmentation surgery. They are there to help address your concerns and ensure the best possible outcome.

Thank you for the question.

Unfortunately, there is no way of knowing in your specific case what the cause of the rippling and/or pain is.

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.

The pain you are experiencing may be related to nerve impingement and/or implant malposition (the breast implant is putting pressure on the under surface of the skin).  If the latter is the case revision yesterday may be helpful.

Continue to follow-up with your plastic surgeon communicate questions or concerns.

Best wishes.

Hello,
Ripples in that position are common but ripples alone do not hurt. Pain is less common in that location, but could be due to a nearby nerve being stretched over the implant and pressed into it when you do the maneuver you describe.

Depending on where you are in your recovery, it is hard to tell. I perform a lot of revision breast surgery and many women who have looseness or laxity of the implant capsule complain of discomfort when they lean over. I rarly can pinpoint the exact cause in this situation but they are often clinally better after revision surgery aimed at revising or tightening the capsule. I would recommend you see your plastic surgeon so that they can examine you and guide you along in your treatment. Best of luck.
Dr Edwards

Rippling can happen with either silicone gel or saline implant but are more pronounced with saline. Even if you go under the muscle there are always areas that are not completely covered and you will feel the rippling or implant shell - specially if you are thinner. The discomfort depends on how far out you are from your surgery. Some discomfort is expected in the immediate postop period. Make sure you follow-up with your surgeon and ask your questions. If the rippling is bothering you too much, then discuss solutions such as switching to silicone gel or going under the muscle if your current implants are above the muscle. The most important point is to have follow-up with your surgeon. Good luck.

All breast implants have ripples, saline are more severe than silicone gel. This why I put saline filled implants under the pectoralis muscle to try and cover over the ripples. But even with this technique patients with very thing breast tissue will not infrequently have visible ripples that can be seen and felt. Replacing the implants with silicone gel implants can help. Recently I have had some luck in these tough cases by doing fat grafting in the area over the ripples.