Breast implant rippling occurs when folds in the implant can be seen or felt through the skin. This relatively common breast augmentation complication can be addressed through revision surgery.
In this article, Paramus NJ breast augmentation surgeons Dr. Gary D. Breslow and Dr. Jordan P. Farkas answer common questions about implant rippling: what causes it, options for surgical correction, and important things to consider before getting plastic surgery.
What Causes Breast Implant Rippling?
Breast implant rippling is a common unintended effect of breast implant surgery, where the implant can be seen or felt via vertical folds on the inner or outer surface of the breast. This is most noticeable when the patient is bending forward with her breasts hanging down.
Up to 10% of patients will experience rippling after implant surgery. In certain cases it’s deemed severe enough to warrant revision surgery.
All breasts — natural and artificial — owe their unique form to a combination of three tissues:
- Structural tissue holds the breast to the chest wall.
- Soft tissue plumps the breast, giving it its pliable form.
- Skin drapes the breast and molds to the soft tissue.
In aesthetic breast implant surgery, the soft tissue of the breast is augmented with a saline or silicone implant. After surgery, the surface of the breast can visibly “ripple” in either of the following cases:
- The overlying soft tissue is too thin in relation to the implant.
- The shell of the implant is underfilled or overfilled.
- The overlying soft tissue is asymmetrically tethered to the implant.
Insufficient Soft Tissue Coverage
Breast implant rippling is more likely to occur when the overlying natural breast tissue is insufficient in relation with the implant’s size.
This can occur in the following cases:
- The implants are very large, and/or the patient is very slim.
- The implant is placed over the pectoralis muscle (this is known as subglandular placement).
- The patient is a cancer survivor who underwent extensive resection prior to breast implant surgery.
Our bodies tell the story of our lives. They change as we age, remodeling in response to external forces like gravity, and internal forces like hormone changes or illness. But implants are not capable of remodeling. While an implant might be a perfect fit for you at one point in your life, if the soft tissue of your breast changes unexpectedly, the implant might start to ripple and need to be adjusted.
This is more likely to occur after significant weight loss, pregnancy, or breast-feeding.
Overfilled or Underfilled Contents
While any type of implant can potentially ripple where it meets the overlying breast tissue, only saline implants are likely to ripple between the outer surface of the implant and its liquid core.
This is because silicone breast implants come with a preset filling, while saline implants are injected. Rippling can occur if a saline implant is overfilled or underfilled relative to the manufacturer’s recommendations.
Overfilling causes the outer shell of the implant to stretch out of shape and wrinkle. In underfilling, the outer shell is excessive due to the amount of filling material, causing it to fold and sag inwards.
Patients heal differently after surgery, even when the same surgical techniques are employed. Rippling can develop when the breast tissue contracts unexpectedly during healing.
Textured implants pose a higher risk of rippling. Because they are designed to adhere to the overlying soft tissue, this adherence can sometimes pull on the breast in unexpected ways and cause rippling as the tissue heals. This is more likely to occur when the tissue is thin.
How Is Breast Implant Rippling Corrected?
Surgical techniques to correct breast implant rippling vary depending on the patient’s overall health, desired aesthetic outcome, and the causes of rippling.
There are two basic options for correcting breast implant rippling:
- Reducing the size mismatch between the natural soft tissue of the breast and the implant.
- Adding soft tissue coverage over the implant.
For saline implants that are over or underfilled, your surgeon can perform an in-office procedure under local anesthetic to inject or remove content. While this can correct the rippling, it may also void the manufacturer’s warranty on the implant.
In some cases, it may be preferable to remove the implant and replace with one of a different size. Your surgeon may also recommend exchanging a saline implant for a silicone implant, or relocating an implant that was placed over the pectoralis muscle so that it’s underneath the muscle instead.
Choosing the Right Surgeon
Everyone’s body responds uniquely to surgery, and aesthetic procedures are no exception. Severe rippling is a highly undesirable breast enhancement complication — it’s normal to feel disappointed if this happens to you.
If you are considering revision surgery, scheduling a consultation with an experienced plastic surgeon will allow you assess your options. He or she will determine the severity and causes of the rippling, explain the range of surgical procedures available to correct the condition, and see how these options can be tailored to address your individual needs.
Plastic surgeons take a professional pride in patient satisfaction. Your surgeon will likely want help you achieve the best possible outcome from a breast implant procedure, and this includes correcting undesirable results. If you paid out-of-pocket for your initial procedure, you may be entitled to a reduced rate for revision procedures.
However, it’s always wise to talk to more than one physician before moving ahead with surgery, and it’s also okay to find another care provider if you don’t think you are in good hands.
Feel free to reach out to us for a second opinion — Drs. Gary D. Breslow and Jordan P. Farkas are widely recognized as leading authorities in breast enhancement surgery, and have successfully performed revision procedures on countless patients from New Jersey and beyond.
Additional Reading and References
- Medscape: Submuscular Breast Augmentation Treatment & Management, Surgical Therapy
- Annals of Plastic Surgery: Scar Tissue Flaps for the Correction of Postimplant Breast Rippling
- Aesthetic Plastic Surgery: Capsular Contracture and Ripple Deformity of Breast Implants