Breast Implants: what causes rippling and how to fix it

Women who have breast reconstruction with saline or silicone breast implants sometimes develop rippling, the appearance of visible ridges or wrinkles in the implant that show through the skin. Rippling usually develops on the outer perimeter of the reconstructed breast: on the side, bottom or in between the breasts. It may be especially visible on the top of the breast when you lean forward. It is more likely to be visible in very thin women.

What Can Be Done About Rippling?

Unfortunately, massaging, exercising or special skin products cannot get rid of rippling. In most cases, correcting the problem involves a trip back to the OR for revision surgery with one of the following fixes.

Replace the implant. Swapping out an implant sometimes eliminates rippling:

- Opt for a larger size. Implants that are too small for the pocket under the muscle can shift until they settle at the bottom of the breast, creating less volume and potentially more rippling at the top. This is often the case when the pocket is too large for the implant, or the remaining breast skin is very thin or damaged.

- Switch to silicone. Silicone implants ripple less than saline implants; this is particularly true of cohesive gel "gummy bear" silicone implants that fill out the shell more smoothly and consistently than less viscous forms of fillers.

- Replace textured with smooth. Textured implants are designed to minimize capsular contracture and to keep teardrop-shaped implants in place so that they don’t move around (or tip over) in the pocket. The roughened surface stabilizes the position of the implant by sticking to tissue (somewhat like Velcro), and that can cause rippling.

Add more saline. All saline breast implants, regardless of size, shape or model, have a recommended minimum and maximum amount of saline that should be added. (Silicone implants, on the other hand, are filled and sealed at the factory and cannot be altered.) An implant, for example, may have a recommended fill range of 300-330cc. Adding 300cc will create a softer breast, but also increases the likelihood of developing ripples, wrinkles, and folds in the implant shell, and that can eventually cause the implant to rupture. Adding 330cc is less likely to create rippling but will result in a breast that is not quite as soft. In this example, “underfilling” (adding less than 300cc) or “overfilling” (adding more than 330cc) may cause the implant to fail, and may void the manufacturer’s warranty.

Add an acellular dermal matrix. Covering the areas of rippling with a layer of acellular dermal matrix (e.g., AlloDerm or Strattice) creates an additional barrier between the implant and the breast skin. 

Reposition the implant. Unlike implants that are used for augmentation and can be positioned either in front of or behind the muscle, implants used for breast reconstruction are almost always placed under the muscle, since the breast tissue has been removed. A few recontructive surgeons (very few!) prefer to place breast implants over the muscle. In this situation, rippling that develops may be improved or rectified by repositioning the implants beneath the muscle.

Add some fat. Depending on the circumstances, a few small injections of fat  liposuctioned from hips, thighs or stomach can make ripples less noticeable.