Do Small Saline Breast Implants Ripple Much?

Thank you for your question.All implants experience rippling, to various degrees. It is just a matter of whether one can see them or feel them. Visible rippling is an issue for most patients, and if you cannot tolerate it, then you may not be a good candidate for breast augmentation, and fat transfer breast augmentation may be a better alternative.Saline implants have more prominent rippling compared to silicone implants because saline is not cohesive (gel-like) compared to silicone.Let us understand rippling a bit better.Rippling is the appearance of ridges, wrinkling, or scalloping on the implant that may be visible through the skin. Women who have at least 2cm of pinch thickness to their skin/fat overlying the implant will not see much if any rippling.  Very skinny women will see rippling no matter what (since all implants have some degree of rippling).  Rippling can be seen on the outer perimeter of augmented breasts: on the side, bottom, or in between the breasts. Rippling can be caused by the under-filling of the implant, or because of pull on the tissue capsule that is attached to thin overlying soft tissue (i.e., skin and subcutaneous fat tissue, and breast tissue). Unfortunately, rippling worsens with time as the implant puts pressure on the breast tissue and thins the overlying tissue. Rippling is common in patients who are very skinny, have very little fat to hide the implant, and have small breasts compared to the implant itself. Weight loss may worsen the situation.To correct rippling there are solutions depending on their applicability:- If someone has under-filled saline implants, have them over-filled moderately.This is more of a preventative measure. Over-filling prevents the shell from folding onto itself although, it can result in unnatural firmness.- If someone has textured implants, have it changed for a smooth surface- If someone has large implants, have it changed for moderate sized implants so that breasts can better conceal the implant- If someone has saline implants, have it changed for a silicone implant (although this will only slightly improve rippling)- If someone has the implant placed above the muscle (subglandularly), then have it placed behind the muscle (submuscularly)Saline implants ripple more over the muscle (subglandularly), but the rippling can be hidden behind the pectoralis major muscle due to a thicker layer of soft tissue that conceals 2/3rd of the top of the implant. Rippling may still appear on the outer side of the breast, just above the breast fold and this is especially true if you lean forward or bend to pick up something off the floor.Final 2 solutions can be applied in any case:Weight gain – weight gain will allow greater soft-tissue coverage – i.e., padding – the better the implants and rippling is concealed.  But since this is not an option most women would chose, fat transfer could be considered.Fat transfers soft tissue for additional support and coverage to area where the implant is visibleThis is the only surgical option, but there is unpredictability in the outcome due to less than 60% fat graft take. Also note that rippling is often a problem for thin patients, and such patients have very minimal fat for fat transfer.That being said, it definitely looks like you are taking precautions to avoid rippling: having the implant moderately overfilled by 20 cc extra (250 --> 270), you are going for a moderate sized implant (I am assuming this is not overly large considering your breast characteristics, such as breast width and skin stretch), and you are placing it in the subpectoral pocket. All these things will help.Hope that helps.

Thank you for your question.  For patients 22 years of age and older who are looking for a natural enhancement, I actually prefer to use silicone gel implants.  Saline implants have a natural ripple to the implant which is almost unavoidable unless the patient has a significant amount of breast tissue to begin with.  This rippling can be either visible or palpable regardless of the implant being placed sub-glandular or sub-pectoral.  With that said, rippling can occur with silicone gel implants, but this is a rarer phenomenon.  I hope you find this helpful and best of luck!

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