Implant rippling is a condition where visible or palpable folds and wrinkles form in the shell of a breast implant. The visibility of these folds is usually most apparent along the sides or bottom of the breast, areas where the natural tissue coverage is typically thinnest. The primary question for patients experiencing this is whether this textural irregularity is a temporary post-surgical effect or a permanent anatomical challenge requiring further intervention.
Anatomical and Implant Factors
The structural appearance of rippling is fundamentally linked to the amount of soft tissue covering the implant. Patients with a naturally thin layer of glandular tissue and fat are at a higher risk because the implant’s folds have less cushion to hide behind. This lack of natural padding means the implant’s texture can be easily transmitted through the skin, especially in specific positions like leaning forward.
Implant placement plays a significant role in determining the degree of overlying coverage. Placing the implant in a subpectoral plane, beneath the chest muscle, generally provides a thicker barrier of tissue between the implant and the skin. Conversely, subglandular placement, where the implant rests over the muscle, offers less protection, increasing the likelihood of visible rippling, particularly in the lower and outer quadrants of the breast.
The type of implant filler also influences the potential for rippling. Saline implants, which contain a sterile saltwater solution, are historically more prone to wrinkling than silicone implants. The liquid nature of the saline filler allows the shell to fold more readily, and if the implant is underfilled, the tendency for visible folds is even greater. Silicone implants, especially those filled with a highly cohesive gel, are less likely to ripple because the gel’s consistency helps the implant maintain its shape and smooth contour more effectively.
Timeline for Resolution
Whether rippling resolves naturally depends entirely on its underlying cause, distinguishing between temporary post-operative changes and chronic anatomical issues. Early rippling seen immediately following surgery is often temporary, caused by acute post-surgical swelling and tissue firmness. As the initial swelling subsides and the surrounding tissues begin to soften, this early, temporary rippling frequently diminishes on its own.
This natural settling process, often called “drop and fluff,” typically takes between three to six months for the majority of swelling to resolve and for the implant to assume its final position. If the rippling is primarily due to this temporary inflammation and tissue tightness, it is likely to resolve as the body completes the healing phase. If the rippling persists after this initial six-month period, however, it suggests a more fundamental structural issue, such as insufficient tissue coverage or implant choice.
Rippling caused by a thin anatomical envelope is considered a chronic condition that will not resolve without intervention. A significant change in body mass can also introduce new rippling years after the initial surgery. Substantial weight loss can reduce the amount of fat tissue overlying the implant, effectively thinning the soft tissue barrier and making previously undetectable folds visible or palpable.
Options for Correction
For patients with chronic, persistent rippling that does not resolve after the initial healing period, several surgical options are available to provide a permanent remedy. One of the most common and effective techniques is fat grafting, also known as lipofilling. This procedure involves harvesting fat cells from another part of the body, purifying the fat, and then injecting it directly into the breast tissue over the rippled areas of the implant. This injected fat acts as a natural, permanent cushioning layer, thickening the soft tissue envelope to smooth out the visible folds.
Revision surgery is another method that addresses the underlying structural cause of the rippling. This may involve exchanging the current implants for a different type, such as switching from saline to a highly cohesive silicone gel implant, which has a lower tendency to fold. Alternatively, the surgeon may change the implant placement, moving the implant from a subglandular (over the muscle) position to a subpectoral (under the muscle) position to utilize the pectoralis muscle for additional coverage.
In more complex revision cases, supportive biological materials can be introduced to reinforce the implant pocket. Acellular Dermal Matrix (ADM) products, such as AlloDerm or Strattice, are biological fabrics derived from donated human or animal tissue. These materials are used to create a sling or mesh that provides structural support and additional tissue coverage, particularly in the lower pole or periphery of the breast where rippling is most common.