Breast augmentation utilizes medical devices to enhance breast size and shape. A potential outcome is implant rippling, which refers to the visible or palpable folds and wrinkles of the implant shell beneath the skin. The term “gummy bear implants” describes a specific type of device filled with a highly cohesive, form-stable silicone gel that maintains its shape even if the outer shell is compromised. This advanced material science leads many to wonder if this specific implant type can still develop noticeable surface irregularities.
What Causes Breast Implant Rippling?
Implant rippling is primarily a physical and anatomical phenomenon resulting from the interaction between the implant and the surrounding body tissues. Every breast implant shell is a flexible envelope that can develop folds or wrinkles. Rippling occurs when these folds become apparent through the skin, either visually or to the touch.
The fundamental reason these folds are noticeable is the lack of sufficient soft tissue coverage over the implant surface. Patients with very thin skin, minimal natural breast tissue, or low body fat percentages have less natural padding to camouflage the implant’s surface irregularities. This issue is most often seen along the sides and top of the breast where the natural tissue is thinnest. Traditional silicone gel implants, which contain a less viscous gel, can still fold within the pocket. When the implant is placed in a pocket that is too large, it can shift excessively, allowing the shell to crease. This mechanical folding, combined with minimal soft tissue, creates the visible waviness.
The Highly Cohesive Gel Advantage
The “gummy bear” designation highlights the unique material science of these implants, which are filled with a highly cohesive, cross-linked silicone gel. This gel has a high degree of viscosity, meaning it is thick and sticky, much like its candy namesake. The increased internal resistance of the gel is directly related to a higher density of chemical bonds within the silicone polymer structure.
This highly cohesive nature gives the implant “form stability,” allowing it to retain its pre-designed shape even when cut. Because the gel resists flow and holds the shell taut from the inside, it is significantly less likely to collapse or fold upon itself compared to less cohesive gels. This structural integrity minimizes the chance of the shell developing the creases that lead to visible rippling. The internal pressure and shape memory actively work to keep the implant surface smooth. This property reduces the device-related contribution to rippling.
Factors That Influence Rippling Risk
While the highly cohesive gel significantly lowers the inherent risk of rippling, it does not make the implant entirely immune to the phenomenon. Rippling with a gummy bear implant is typically a result of a combination of patient anatomy and surgical technique. The most significant factor remains the amount of soft tissue coverage over the implant.
Patients with very low body mass index (BMI) and minimal native breast tissue still face an elevated risk because even a highly cohesive implant may have a palpable edge or minor fold that can be felt through the thin overlaying skin. Furthermore, the size of the implant plays a role; a larger implant requires more surrounding tissue for complete concealment. Choosing an implant that is too large for the patient’s existing breast footprint can stretch the skin too thin, making any subtle fold visible.
The placement of the implant within the breast pocket is another major determinant of rippling risk. Submuscular placement, where the implant is positioned partially beneath the pectoralis major muscle, provides an extra layer of tissue coverage, particularly over the upper portion of the implant. This additional barrier effectively hides minor surface irregularities and is generally recommended for thinner patients. Conversely, subglandular placement relies solely on the natural breast tissue and skin for coverage and carries a higher risk.
Managing and Treating Rippling Concerns
For patients who experience subtle or visible rippling with their cohesive gel implants, several corrective and preventative strategies exist. One common non-surgical approach involves autologous fat grafting, which uses the patient’s own fat harvested from another area of the body. This fat is injected directly into the breast tissue overlying the implant, effectively increasing the soft tissue padding to camouflage the folds.
Surgical revision is another option, often involving an implant exchange or a change in the implant pocket. If the implant was placed above the muscle, a submuscular conversion can be performed to move the device under the additional protection of the pectoral muscle. In cases where the implant is deemed too large or the pocket is too expansive, a change to a smaller implant or a reduction in the pocket size can help secure the implant and minimize movement and folding. Surgeons may also utilize advanced materials like acellular dermal matrix, a supportive tissue scaffold, to provide additional coverage and support over the implant’s edges.