“Gummy bear implants” is a common term for highly cohesive silicone gel implants, named for the thick, candy-like consistency of the silicone filler. This advanced gel composition allows the implant to maintain its shape even if the outer shell is compromised, a significant improvement over earlier, more fluid silicone gels. Despite their enhanced structure, patients often worry if these implants can still lead to rippling. While the cohesive nature of the internal gel significantly reduces the risk, rippling remains possible, depending on biomechanical and anatomical factors.
The Core Mechanism of Rippling
Cohesive gel implants are resistant to the rippling common with saline implants, where underfilling causes excessive shell folding. Rippling can still occur because the outer shell of any breast implant is flexible and thin. When the cohesive gel volume does not completely fill the shell’s boundaries in certain positions, the shell must fold or wrinkle. This folding is a physical consequence of the implant’s design, resulting in a ripple in the outer envelope, not the cohesive gel itself.
The thick internal gel prevents gross folding of the implant body. However, the implant’s outer edges are susceptible to wrinkling when surrounding tissue lacks support or compression. In some cases, the textured surface of certain cohesive implants can adhere to the scar capsule. This tethering may cause the outer layer of tissue to dimple, creating a visible ripple.
Anatomic and Surgical Risk Factors
Rippling visibility is directly tied to the thickness of the tissue layer covering the implant. Patients with minimal natural breast tissue or low body fat are at higher risk because they have less padding to mask subtle shell folds. Weight reduction after surgery can also increase rippling prominence as overlying breast tissue volume decreases. The thickness and elasticity of a patient’s native skin also contribute to the visibility of the implant’s edges.
The choice of implant size relative to the patient’s chest width also influences rippling risk. If an implant is too large for the existing breast footprint, its edges are more likely to press against thin tissue and become visible. Surgical placement is a primary variable in mitigating this risk. Subglandular placement (above the chest muscle) offers the least tissue coverage, increasing the chance of visible rippling. Conversely, submuscular placement (beneath the pectoral muscle) uses the muscle as a thicker, masking layer to camouflage shell folds.
Identifying Rippling
Rippling is characterized by wrinkles, waves, or folds on the surface of the breast skin. It is most often seen or felt along the implant’s edges, such as the outer sides near the armpit or the upper portion. This aesthetic concern becomes more pronounced when a patient leans forward or contracts the chest muscles, shifting the implant’s position. Patients may be able to feel the folds under the skin, even if they are not noticeable to the eye.
Rippling must be distinguished from other post-operative complications, such as capsular contracture or implant rupture. Rippling is primarily an aesthetic issue that does not usually affect overall health. An implant rupture involves a breach of the shell and is best detected through imaging like an MRI. Capsular contracture involves the hardening and tightening of scar tissue, presenting as a firm, distorted breast shape rather than a wave or fold.
Addressing Rippling
Prevention begins during the initial surgery through careful planning and technique. Surgeons often recommend submuscular placement for patients with thin native tissue, as the added muscle layer provides cushioning over the implant shell. Choosing an implant size appropriate for the patient’s frame is also preventative, avoiding undue tension on surrounding tissue.
If rippling has developed, several management and revision options are available. A common non-surgical approach is fat grafting, where the patient’s own fat is harvested and injected over the implant where folds are visible. This adds a layer of soft tissue to camouflage the ripples. Surgical revision may involve changing the implant size, altering pocket placement from subglandular to submuscular, or using acellular dermal matrix to create thicker coverage.