Breast implants carry not only surgical risks, but cosmetic as well. One of the most common cosmetic flaws with augmentation surgery is rippling. Rippling, also known as “wrinkling,” is very much like it sounds: the breast implants create a wavy or rippled appearance or feeling of the breast.

Types of Rippling:

Rippling can be of two varieties: shell rippling or traction rippling. Shell rippling is more common and most often happens with saline implants, as they have a tendency to collapse in on themselves, and often fold as well, since they have a lower viscosity than silicone. Overfilling a silicone implant can avoid this to an extent, though severely overfilling can lead to ripples along the “equator” of the implant (called “tension bands”) and may look and feel less natural.

Textured surface implants can cause “traction rippling.” These implants were designed to lessen scar tissue at the surgical site, but can cause this type of very visible track mark-like rippling. Traction rippling occurs most frequently with anatomical or teardrop shaped implants and is only a visible surface feature, not an internal complication.  

This occurs because the implant pulls down upon existing breast tissue, and can only be corrected by switching out the implant with a new, smaller version.

Common Causes:

Scar tissue can be a factor in rippling. Over time, the natural breast tissue can form scar tissue around or near the implant site. As these scars develop, it changes the breast implant pocket, which can affect the implant itself and cause visible rippling. It can be corrected by having what is called a “capsulectomy” that removes scar tissue from around the implant and smoothes the pocket.

Weight loss can also change the implant pocket; as natural breast tissue fluctuates, the pocket can alter, causing various degrees of rippling. This may be of particular concern for naturally petite women who already may find their implants ripple after surgery. In these cases, it is likely they did not have enough fat to “pad” the implant in the first place. The easiest fix for this is to gain a few pounds, though that may be easier said than desired for many women.

Rippling immediately after surgery usually disappears as the body heals. It’s important to remember that breast implant rippling is a cosmetic flaw only; that is, it’s not a defect of the implant itself or a dangerous side effect. “Unders” (implants placed under the submuscular tissue) and silicone or gel (versus saline) implants are much less likely to ripple. Dr. Pelletiere, a plastic surgeon from Chicago, notes; “Because the silicone implants have a thicker filling material, the ripples do not feel as prominent, and feel softer. With the saline implants, because it is just water behind the shell, they feel sharper/ more prominent.”

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Surgical solutions to rippling include: placement of a layer of alloderm or strattice (very expensive), fat grafting to the breast (technically difficult), injections of commercially available fillers or simply replacing the implant. None of these solutions are truly ideal, so it is best to try and avoid rippling in the first place by educating yourself about the best type and placement of implants for your body. As with all elective surgeries, research your surgeon and make sure both of you are aware of all the details before beginning.