Causes of Breast Implant Rippling and How To Prevent It

Breast Implant

Rippling after breast augmentation with implants is visible folds on the surface of the skin. The rippling can sometimes appear in some quadrants of the breast depending on the technique used and the anatomical qualities of the patient. The diagnosis is subjective, and the characteristics of women and implants are different, which is why it is always important to take the necessary measures to prevent implant rippling. Probably the most common cause of this is choosing an inadequate implant size.

The breast implant size and type should always be chosen after the recommendation of the plastic surgeon. His expert suggestions take into consideration the size of the existing mammary tissue and the patient’s other anatomical characteristics.

Physiopathology of Rippling

The formation of folds after breast augmentation with implants is due to two phenomena often associated with each other. The rippling is related to the content of the prosthesis which is due to the cohesiveness of gel for silicone implants and underfilling for saline solution implants, also known as "underfill rippling" and "pulling rippling”. When the patient does not have enough skin and mammary gland tissue to properly cover the implants (usually we are talking about thin patients), these folds can become visible and cause the rippling effect.

Causes of rippling:

There are various causes of rippling after breast augmentation:

•    Not enough breast tissue to cover the implants:

o    Very thin patients with thin skin and thin subcutaneous adipose tissue

o    Severe mammary gland atrophy

o    Narrow mammary base and/or when the base of the breast implant protrudes beyond the base of the breast. This is a case of breast augmentation with implants that are too large in volume.

•    The characteristics of the breast implants used:

o    The level of filling of the breast implants. Here, we are talking about saline solution breast implants. This type of implant is empty and the plastic surgeon will fill them with liquid during the procedure. When they are underfilled, they can form wrinkles that can be visible to the naked eye if the overlay mammary gland is thin. At the same time, overfilling the breast implants with saline solution can prevent the rippling but will also decrease the flexibility of the breasts.

o    Textured breast implants

o    Large breast implants. They create traction ripplings by the weight exerted on the capsule. Ripplings may appear late after the procedure was performed, not necessarily during the first year. 

o    The cohesiveness of the silicone gel

•    Capsular contracture. This is a natural occurrence after breast implant surgery. The body will try to isolate the implant by creating a fibrous tissue around it. If the capsule becomes hard and starts distorting the implant, ripplings can occur.

The delayed appearance of the ripplings several years after the breast augmentation surgery may be explained by the progressive decrease in the filling coefficient (progressive deflation of saline solution breast implants or silicone gel implants) and by the reduction of the covering mammary tissue that can occur after pregnancy, breastfeeding, losing weight or with the natural aging process (age-related breast atrophy).

The rippling is essentially an aesthetic issue, not a medical complication. When the rippling is visible in the cleavage, they are particularly unpleasant and most often require treatment. In rare cases, the folds of the implant shell, in addition to their unpleasant appearance, can cause the implant to rupture and even expose it by the erosion of the breast tissue. As we have already mentioned, this is a very uncommon complication and only occurs when the folds are very large.

How to Prevent Breast Implant Rippling

There are three key points during breast augmentation that should be remembered to prevent the formation of ripplings:

1. The plastic surgeon should fill the saline solution implants just enough. Concerning pre-filled silicone gel breast implants, the degree of filling, and the cohesiveness of the gel varies depending on different brands.

2. The placement of the breast implants should be made under the pectoral muscle if there is no considerable mammary gland thickness to cover them.

3. Avoid choosing a breast implant of excessive volume (more than 350 ccs) for petite patients with thin mammary tissue. If the patient desires a large volume breast augmentation, genuine information and education must be carried out to make them consider a more reasonable choice of implant size.

Rippling Treatment After Breast Augmentation Surgery:

Nowadays, we have multiple available techniques to correct the rippling effect of breast implants. Among them are:

-    If the rippling occurs as a result of weight loss, a fat transfer to the breasts can correct the issue.

-    If the rippling occurs because of the use of older generation breast implants, a change in breast implants can correct the problem. Choosing implants with a more cohesive silicone gel filling is important.

-    If the rippling comes as a result of the implant placement under the mammary gland, an intervention can be performed to move them under the pectoral muscle.

-    If the rippling is caused by using implants that are too large, the plastic surgeon might advise you to replace them with smaller ones. In this case, additional procedures might need to be performed such as a breast lift.

Conclusion

Breast implant rippling is a phenomenon that can occur after breast augmentation surgery. It can be caused by many factors such as the inappropriate size or type of the implants used, the patient not having enough mammary tissue to cover them, the placement of the implants, and even a significant weight loss or just the natural aging process.

It is important to remember that the rippling is not a medical condition, but an aesthetic concern. It can be treated in different ways, depending on the cause.