Breast implant rippling is a relatively common concern among individuals who have undergone breast augmentation surgery. This condition refers to the visible or palpable folds and wrinkles that can appear on the surface of the breast, giving the skin an uneven texture. While rippling is not necessarily harmful to health, it can significantly affect the aesthetic results of breast augmentation, causing distress and dissatisfaction for some patients. There are a number of factors that result in more visible rippling.

What Causes Breast Implant Rippling?

Understanding the causes of breast implant rippling is essential for prevention and treatment. There are some factors that can be difficult to correct due your anatomy or implant technology. Several factors contribute to the development of this condition, including:

1. Implant Fill Material

Saline implants are notably more prone to rippling compared to silicone gel implants. Saline implants contain a saltwater solution, which has lower viscosity than silicone gel. This means the saline solution moves more freely within the implant shell, allowing folds and wrinkles to form more easily. Conversely, silicone implants have a thicker, more cohesive gel that better maintains the implant’s shape, significantly reducing the likelihood of rippling. In the UK, saline implants are rarely used but you can still get rippling with silicone implants. The fill of the implant is an important factor in rippling. Most implants are not filled fully so they have some softness to them. This means that they can develop folds or ripples which is normal. If an implant is filled fully they tend to be more solid and not feel as natural. There are some types of implants that are filled slightly more such as the Mentor Memory Gel Xtra or some Motiva implants. These may have less rippling but may still develop this.

2. Implant Placement

The position of the implant within the breast greatly influences rippling. Subglandular placement (above the muscle but beneath the breast tissue) provides less natural tissue coverage, increasing the visibility of ripples, particularly in patients with thin breast tissue. On the other hand, submuscular placement (beneath the pectoralis major muscle) offers better coverage, substantially reducing the risk of rippling. Some very slim patients will always develop some degree of rippling even when the implant is placed under the muscle.

3. Patient Anatomy

The patient’s body characteristics significantly impact the occurrence of rippling. Individuals with thin or minimal natural breast tissue, low body fat, or very slim body frames are more susceptible to noticeable rippling due to insufficient soft tissue coverage to conceal implant edges or folds. The skin also thins with time and this can result in more visible rippling. Patients with more tissue are less likely to develop rippling as there is more tissue to cover the breast implants.

5. Implant Size

Selecting implants that are disproportionately large relative to the patient’s natural breast tissue and body frame can cause stretching and thinning of the breast tissue and skin. This stretching can lead to visible rippling, as the tissue coverage becomes insufficient to conceal the implant adequately.

Is Implant Rippling Normal?

Rippling can be considered normal, especially in certain positions or lighting conditions. For example, some patients might notice slight rippling when bending forward or lying down. However, more pronounced rippling that is visible at rest or through clothing can occur with weight changes and due to the factors discussed already.

Reducing the Risk of Rippling

There are several approaches that can help reduce the risk of developing implant rippling:

1. Opt for Silicone Implants

Choosing silicone gel implants over saline significantly reduces the risk of rippling due to the gel’s cohesive nature. Silicone implants maintain their shape better, providing a smoother, more natural appearance. The higher cohesive gel implants such as Memory Gel Xtra or Motiva implants may have lower rippling risk when compared less cohesive gel implants.

2. Submuscular Implant Placement

Placing implants beneath the chest muscle provides additional tissue coverage, masking potential rippling effectively. This approach is particularly beneficial for patients with thin breast tissue or a slim physique.

3. Appropriate Implant Sizing

Selecting the right implant size that aligns proportionately with the patient’s natural breast dimensions and body structure is crucial. This reduces tissue strain and helps prevent rippling from occurring.

4. Enhancing Tissue Coverage

In patients with thin breast tissue, additional procedures such as fat grafting (lipomodelling) or using acellular dermal matrices or mesh can increase soft tissue coverage. These methods can help diminish the visibility of rippling.

Why Am I Experiencing Rippling?

If you are experiencing noticeable implant rippling, several factors might be at play:

• Implant Type: If saline implants were selected, their fluid nature might contribute significantly to the issue.
• Placement Position: Implants placed above the muscle (subglandular) in individuals with minimal tissue coverage are more prone to rippling.
• Body Composition: Individuals with thin breast tissue or low body fat will inherently have a higher risk of rippling.
• Implant Size Issues: Implants that are too large for your natural anatomy can cause tissue stretching, resulting in rippling.
• Weight Change: If you have recently lost weight then this is likely to contribute to the risk of more noticeable rippling.
• Skin Changes: As we age the skin thins and this also happens after implants have been in for a long time. The thinning of the skin or laxity can result in rippling.

Treating Implant Rippling

If rippling has become a concern, several treatments can address and significantly improve the condition:

1. Fat Grafting

Fat grafting, also known as lipomodelling, involves harvesting fat from other parts of your body and injecting it into the breast. This procedure increases the thickness of breast tissue covering the implant, effectively camouflaging ripples and improving overall breast contour and appearance.

2. Implant Exchange

Swapping saline implants for cohesive silicone gel implants can significantly reduce rippling. Silicone implants maintain their shape better and offer a smoother, more natural look and feel. We often find that patients will change to the more filled implants when having exchange of breast implants surgery.

3. Changing Implant Position

Repositioning the implants from above to below the muscle (submuscular placement) provides additional soft tissue coverage. This approach effectively masks rippling, especially in patients with thin breast tissue.

4. Using Acellular Dermal Matrix (ADM)

Acellular dermal matrix is a natural material used to reinforce the breast tissue around the implant. During a revision surgery, ADM provides an extra layer of support, smoothing out the implant’s surface and significantly improving the cosmetic outcome.

5. Superior Coverage Technique

This surgical approach involves using part of the chest muscle (pectoralis major) to provide better coverage over the implant’s upper portion, reducing rippling visibility. Research has shown this technique effectively reduces the prevalence and visibility of rippling. This is essentially changing the plane of the implant from over to under the muscle.

6. Skin Tightening

Some patients may have skin laxity which occurs with ageing, pregnancy, breast feeding and having had implants. There is often improvement in the rippling when the skin is tightened using a breast lift which can also include a change of implants at the same time.

Conclusion

Breast implant rippling, while generally considered normal and harmless, can significantly impact the aesthetic satisfaction of breast augmentation patients. Understanding its causes and risk factors helps in both prevention and treatment. Modern surgical techniques and implant options have considerably reduced the incidence and severity of rippling. If you experience rippling, book a consultation with Mr Nassab to discuss options and suitable corrective measures tailored specifically to your needs. With appropriate intervention, significant improvements in breast appearance and patient confidence can be achieved.