Breast augmentation using silicone implants is a widely performed procedure, but patients often have questions about the long-term aesthetic outcomes. Among the common concerns is the issue of implant rippling. This phenomenon can affect the smooth contour of the breast, leading to an appearance that is less natural than desired. Understanding the mechanism behind rippling and the factors that influence its visibility is the first step in addressing this aesthetic issue.
Understanding Implant Rippling
Implant rippling, also referred to as folding, is a physical manifestation of the implant shell wrinkling beneath the skin. This occurs when the implant’s outer silicone shell folds slightly within the surgical pocket, which is a natural tendency for soft, flexible materials. The wrinkling can be both visible, appearing as a wave or wrinkle on the surface of the breast, and palpable, feeling like ridges or folds when touched. Rippling is often most noticeable in areas where the natural tissue coverage is thinnest, such as along the sides of the breast or near the cleavage.
The underlying cause of visible rippling is insufficient tissue or material covering the implant to mask the slight folding of the shell. The visibility of the folds is directly related to the amount of natural padding—fatty tissue, glandular tissue, and skin—between the implant and the skin’s surface. While the question focuses on silicone implants, the mechanism of folding is relevant to all implant types. When this protective layer is too thin, the subtle folds in the implant shell become apparent.
Key Variables That Increase Rippling Risk
Patient Anatomy
The primary factor influencing rippling risk is the patient’s native anatomy, specifically the thickness of their breast tissue and the overall body fat percentage. Individuals with very little natural breast tissue or a low body mass index (BMI) lack the necessary padding to camouflage the implant shell folds. Significant weight loss following the surgery can also increase rippling risk by reducing the amount of protective tissue covering the implant over time.
Implant Placement
Implant placement is a major surgical determinant of rippling visibility. Subglandular placement, which positions the implant above the chest muscle, provides the least amount of tissue coverage, increasing the risk of rippling. Placing the implant in a submuscular or dual-plane position, which covers the implant partially or fully with the pectoralis muscle, significantly lowers this risk because the muscle acts as an additional layer of tissue support. Surgeons often recommend submuscular placement for patients who present with naturally thin breast tissue.
Implant Characteristics
The specifications of the implant itself also play a role in the probability of folding. Larger implants have more surface area that is unsupported by the surrounding tissue, which can increase the likelihood of the shell folding. Choosing an implant size that is too large for the patient’s chest width can also create tension on the surrounding tissue, potentially leading to noticeable wrinkles.
Modern silicone implants, particularly those referred to as highly cohesive gel implants or “gummy bear” implants, are structurally firmer and less likely to fold than older generations. The cohesive nature of the silicone gel helps the implant maintain its shape, which naturally reduces the formation of wrinkles in the shell. While highly cohesive implants reduce the risk, the potential for rippling is never entirely eliminated, especially in high-risk patients with very thin overlying tissue.
Prevention and Correction Strategies
Preventing rippling begins with meticulous surgical planning and implant selection tailored to the patient’s anatomy. Surgeons can proactively choose submuscular placement, which utilizes the chest muscle as a natural barrier to soften the implant’s contour and edge visibility. Selecting an appropriate implant size and profile that matches the patient’s chest wall dimensions is also important to prevent undue tension or excess unsupported implant shell.
For patients who are experiencing rippling, several corrective procedures are available. A common and effective option is fat grafting, where the patient’s own fat is harvested via liposuction and injected into the breast tissue overlying the implant. This technique effectively adds a layer of natural cushioning, or biological padding, which camouflages the implant folds and smooths the contour.
Surgical revision may be necessary in more severe cases, often involving changing the plane of implant placement. If the implant was placed subglandularly, moving it to a submuscular position can immediately reduce the visibility of the folds by providing greater tissue coverage. The surgeon may also replace the existing implant with a different type, often switching to a highly cohesive silicone gel implant, which is inherently more resistant to folding. Other advanced options include placing an acellular dermal matrix (ADM) or mesh material over the implant to provide an artificial layer of soft tissue coverage.