What to Do About Rippling with Silicon Implants?

I am a little over 4 weeks post op allergan 492cc round mod plus subpectoral augment. I am 33, 5'3" 110lb, with already wide set breasts, previously a 32C with some breast tissue with loose skin. Visible rippling/implant edge laterally, now seeing rippling medially one breast. Options? Thank you!

Doctor Answers 11

How to correct rippling of silicone gel implants under the muscle

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Thank you for your question. I am sorry that you are seeing rippling of the silicon gel implant after sub-muscular breast augmentation. The only solution I can think would be to have a revision during which acellular dermal substrate such as Flex HD, Strattice or AlloDerm is placed over the implant.You will likely need to wait 3 or 4 months for this revision.

Rippling and silicone breast implants

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It is too early at 4 weeks to conclude anything but in general if silicone gel breast implants are rippling it's because of a size discrepancy between the implant and the capsule around it or because the capsule is not smooth and even around the implant. 

The way to understand rippling is that the term is confused between look and feel. All saline-filled implants feel ripply because that's what saline feels like if you can feel it. If the tissue coverage is adequate then it is still ripply but you don't feel it. If the implant isn't filled properly, has a size to capsule problem, or has attachments of the implant to the capsule from surface texturing then the rippling will be worse and can even be visible upright. 

Gel-filled breast implants do not inherently feel ripply. They feel like tissue and this is why they are used because the tissue coverage doesn't matter. In general they don't ripple or feel ripply regardless of the coverage but they can seem to feel ripply if the implant can't position properly in the capsule around it or the capsule is not smooth and/or the implant is attached to the capsule (which yours can't be if they're smooth surface and round Allergan Style 15). 

If the rippling feel persists after full resolution of the tissues, then a revision would be required to make sure the capsule has adequate size for the implant and the capsule is smooth and even. Tissue coverage can be bulked up with a dermal graft like Alloderm but this is expensive and not as important as the characteristics of the capsule at least for gel implants. Another option might be to wait for the 4th generation (gummy bear) gel implants which might help with this problem. Currently the US government will not allow you to choose them although there is extensive experience with them in Canada and elsewhere in the world. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

The use of grafts of an acellular dermal matrix or you own fat are viable solutions.

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When patients have visible rippling following breast augmentation there are several solutions to help correct this problem. These would include repositioning the implant  beneath the pectoral muscle if they had originally been placed above the muscle. If the implants were saline filled then changing the implants to silicon gel would help since the latter are associated with less visible rippling. However, since these maneuvers were incorporated in your original operation the options become more limited. The use of grafts of a acellular dermal matrix or of your own fat over the implants in the areas of visible rippling remain two viable alternatives. You should consult with your Surgeon about these alternatives.

David A. Ross, MD (retired)
Chicago Plastic Surgeon

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Options for rippling with silicone implants.

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The problem you are experiencing are likely due to your thin breast tissue. Options for managment include switching to high profile implants, acellular dermal matrix coverage, fat grafting.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Rippling under the muscle with silicone

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It sounds like you are very thin.  The best way to camouflage the implants is to use a thick piece of alloderm to provide an additional layer of soft tissue coverage.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Ripple can be seen with a silicone gel implant and thin cover

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The appearance of a silicone gel implant can depend on the breast tissue available to hide the implant from view. Submuscular placement is usually the best option, especially in a thin breast. Many are surprised to hear that a silicone implant can indeed ripple or show a fold as can a saline implant. With your current full 492 cc implant, you might consider a smaller size, and  you may have a better result. Another consideration is a form stable implant such as the Allergan 410 implant which has a lessor tendency to ripple.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews


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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.


Wait for your results to appear first

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I recommend you wait until about three or four months after your surgery before assessing your results. You are probably still recovering from the surgery and your breasts still need to drop and settle. At that time, you can then assess your results and talk to your surgeon about them.

Implant rippling options

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Placing the implant under the muscle and using a gel or silicone implant is the best way to minimize rippling.  If the ripples are persistent then you may consider using alloderm (acellular dermis) to line the implant pocket and provide more coverage of the implant.

John L. Burns Jr., MD
Dallas Plastic Surgeon
4.7 out of 5 stars 56 reviews

Options to conceal rippling with silicone implants

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As you have experienced, all implants tend to ripple, some more than others. Yours are style 15 which I think ripple less than other gel implants. So concealment by adding "padding" is what is needed, and you have already made a good choice by going under the muscle. However, there is no muscle coverage laterally or on the bottom, so that is where it is most typically seen. Medially it may be due to partial release of the muscle in order to try to get the implants close together. Options to improve coverage include fat grafting and the use of grafts to the scar capsule. The best material for this is called Strattice. Info here: www.renewingyou.com

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 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.