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.
