Do Small Saline Breast Implants Ripple Much?

I am currently a 32A and would like to increase to about a B size. I have read that saline implants tend to ripple, especially in petite women. However, I ONLY plan to have 250cc saline inflated to 270cc subpectorally. Will rippling be barely noticable, because the implants are small and SUBPECTORAL?

Doctor Answers 33

Rippling, saline implants, and size

Perhaps I can sort out the issues here.

All saline-filled breast implants inherently feel "ripply" because they are filled with saline. All silicone gel-filled breast implants inherently feel like tissue because they are filled with gel. 

Actual rippling in the sense of visible rippling of the shell of the implant is a mechanical problem caused by a number of things including over-filling or under-filling (saline), improper sizing, surface texturing, capsule problems, and lack of tissue coverage. Some of these can be avoided with proper sizing and technique but tissue coverage is what it is and can be predicted but not altered, assuming the implant is subpectoral (below the pectoralis muscle) where it can be covered adequately. This has nothing to do with the size of the implant, again assuming it is fitted, filled, and positioned properly. 

Silicone gel-filled implants have only one advantage over saline implants and that is that they inherently feel like tissue. It's not impossible for them to ripple or knuckle because of surface texturing or capsular problems but they don't inherently feel ripply. Saline-filled implants have all the other advantages but need to be sized, positioned, and filled properly to achieve the same look as a gel-filled implant. I do not think the actual volume of the implant relates to rippling if the other factors are controlled. 

Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

Saline implant ripple may be less that you think

A saline implant does have a tendency to cause a palpable ripple, often at the level of the fold under the breast, or out to the side, though in a submuscular position, visible ripples are rare. It is easy to be over concerned about the risk and I think you would do well with a saline implant. The relative softness is the same as a gel, and will tend to stay softer over time. The incision is smaller and so is the cost. Gel is 'popular' but the saline implant is likely to remain a good option so choose carefully.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 39 reviews

Saline implant rippling

All saline implants ripple when filled within their suggested volumes. Whether or not you are aware of it is dependent on a number of factors. The softer the implant, the less the ripples. As the implant pressure increases either by overfilling  or by external pressure (capsular contracture), the ripples get smoothed out. The chance of seeing or feeling the rippling depends of the amount and thickness of the tissues covering the rippling. Thus, implants that are beyond the dimension of the overlying breast and soft tissue will show more as will those with thinning cover (i.e. subglandular). That is why in order to minimize rippling you should keep the width of the implant narrower than the width of the natural breast tissue (i.e. base width) and place them as deep as possible (i.e. subpectoral). But neither of these factors will guarantee absence of rippling.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 10 reviews

Rippling in saline breast implants

Rippling can be caused by several things. It has more to do with the amount of tissue covering the implants, how loose the skin is and how much the implants are filled. So the size of the implants is not really a major contributor, though of course larger implants can be more visible for a number of reasons (not just limited to rippling).
You can try to minimize rippling by placing implants beneath the muscle and/or using smaller implants and overfilling them slightly. In patients who have problems with recurring rippling, fat injections could be a potential solution as well.
The bottom line is that rippling can occur regardless of the type of implant used or the size used, and the best thing you can do is take steps to minimize it as much as possible. Schedule a consult with a surgeon well-versed in breast augmentation and discuss your unique situation. He or she will be able to make recommendations based on your examine and personal characteristics.

Scott W. Mosser, MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 9 reviews

Rippling and what it means

Essentially, rippling is the visible signs of folding of the implants through the breast. There are two factors involved:

  1. Thickness of the overlying soft tissue (muscle, breast gland, fat)
  2. Qualities inherent in the implant (silicone vs. saline, saline fill volumes)

For thickness, this is usually the one area that we cannot easily change. Women with smaller breasts and less overlying soft tissue will "show" the implants more. Placing the implant under the muscle helps to camouflage this to some degree, however the muscle does not cover the entire implant and rippling can be seen underneath the breast and on the outer aspect. Options exist to increase soft tissue coverage such as dermal matrices (Alloderm/Strattice) and fat injections. However, these are usually done for patients with recurrent problems of rippling.

The implant characteristics are a large part of whether "rippling" is seen. Saline has a lower viscosity than silicone gel and hence "moves" more within the shell of the implant. This allows for a greater degree of folding of the implant shell. We try to counteract this by overfilling the implants by 10-15% which stretches the shell and limits the folding. This overfilling does improve rippling. Silicone gel implants are perceived to ripple less because of their higher viscosity. However, if the overlying tissue is thin enough, you can appreciate rippling just as easily with silicone implants.

The bottom line is that rippling can be a factor in any breast augmentation. For most women, it is a minor problem and doesn't detract much from the overall augmentation. If it is a problem, you always have the options of switching to silicone and/or increasing the soft tissue volume via the methods mentioned earlier.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 16 reviews

Both saline and silicone implants can ripple

The best way to avoid rippling is to place breast implants behind the muscle and avoid choosing a size too large in relation to your natural breast tissue and chest dimensions.   Slightly overfilling saline implants help as well.  Its important to understand a few things about rippling:

  • visible rippling is rare in smaller implants behind the muscle
  • Although saline implants have a slightly higher chance of visible rippling, rippling can occur with both saline AND silicone implants.  There is no guarantee that a silicone implant won't ripple.

Adam Hamawy, MD
Princeton Plastic Surgeon
5.0 out of 5 stars 35 reviews

Ripples with implants

Saline implants have an irregular edge on the outer margin of the implant, silicone implants also have this irregularity but it is less noticeable. When the implant is placed in a patient it sometimes appears as a ripple on the breast . Usually it is more easily palpated than seen.  Most of the time when it is visible the overlying tissue is thin. But in most patients this deformity is not visible .When placed under the muscle it is less likely to become "rippled."

The cost of a silicone implant is much greater than a saline implant  so it is a concern. I have placed the smaller Saline implant in several patients  and most do not complain about rippling.

Walter D. Gracia, MD
Fort Worth Plastic Surgeon
4.5 out of 5 stars 3 reviews

Rippling with small implants

If the implants are placed under the muscle and are overinflated and are on the small side, they are less likely to ripple than a larger implant.  A larger implant will thin out the overlying breast and muscle and the thinner layer will more likely have rippling show through.  Your best bet, however, for no rippling would be a gel implant.

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 63 reviews

Saline implants ripple more than silicone gel implants even under the muscle.

Most often saline implants under the muscle, sub pectoral, give very nice results even in small breasted thin women. There is always the risk of rippling which is significantly higher in saline verses gel implants. So if  you have the option of silicon gel implants under the muscle verses saline under the muscle, the I would definitely recommend you chose gel under the muscle or under the breast.

Carl W. "Rick" Lentz III, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 14 reviews

WHY do Breast Implants RIPPLE?

ALL breast implants ripple. The rippling is a function of the action of the filler on the surrounding shell. Saline breast implants tend to ripple more than silicone gel filled breast implants. In addition, textured surface implants will ripple more than smooth surfaced implants.

This basic fact is the major reason why we cannot place just any size implant into any woman and expect an attractive result. For an attractive result, the patients PRE-surgical breast tissue must be able to cover a prospective implant. Placing a wider implant than the available breast tissue "roof" means that the uncovered areas (including the ripples) will be under the skin and be felt and seen.

Since small breasts women, by definition, have less breast tissue to act as a cover, these woman cannot have large implants without having these implants appear "fake" ; too round and full of folds and ripples. If you do not believe me, read the tens of sorrowful letters by patients who still cannot understand why they look the way they do with large implants.

Ask your surgeon to match your breasts with the most suitable round, smooth silicone gel filled implants (less ripples).'

Good Luck.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 97 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.