Of all the problems that a breast augmentation can have, perhaps rippling is the condition makes patients the most miserable.  When thin women bend over it is not uncommon to see some rippling in the lower outer breast. However, when the problem involves the upper inner breast, or if the entire breast has an unnatural and excessively rippled feel, then that is a problem that justifies consideration for revision.

There are three reasons rippling develops: The first is thin tissue.  Rippling never happens in overweight patients, but it can happen to patients of normal weight who have little of their own breast tissue.  Patients will report rippling coming or going with the gain or loss of even a few pounds. Dr. Teitelbaum once had a frantic call from a patient who was a dancer in a musical that was touring the country.  She said she had been dancing so much and eating so little that she had developed distressing rippling.  What could she do, she wondered?  The answer was not surgery; it was gaining a few pounds. Telling a patient in Southern California to gain weight is not something that goes over so well with patients, but that is the most reliable method to treat rippling - and the least expensive and least risky as well.

The second reason breasts can ripple is an under-filled breast envelope.  For example, if the implant is too small it can drop, settle, and fold in the bottom of the breast.  More commonly, this occurs from thin, damaged, and stretched-out skin that has lost its ability to hold the implant firmly against the body. The third reason for rippling can be by the implant itself.  Implants are manufactured to be soft and pliable, therefore implants have the potential to develop folds.  If implants were made to be totally resistant to folds, they would feel very firm and look too round and too bulgy.  Textured implants ripple more than smooth, and saline implants more than silicone.  Dr. Teitelbaum determines the best treatment after diagnosing which of these issues are the source of your problem.

If the implant is in front of the muscle and the tissue is thin, he may suggest moving the implant behind the muscle.  If the implant is behind the muscle or the muscle is damaged then the situation gets more difficult.  Fat can be injected to thicken the coverage or acellular dermal matrix (ADM) such as Strattice and Alloderm can be used.  Though patients laugh when it is suggested to them, even a modest weight gain can make a huge difference.  It is certainly more natural, less expensive, and even better-looking than any surgical remedy.  If the tissue is very loose, sometimes a lift or a slightly larger implant can be used.  Some implants ripple more than others: saline more than silicone, textured more than smooth.  Also, implants of different “profiles” have different tendencies to ripple.  Finally, highly cohesive implants such as the “410” or the “CPG” can be used but only if the tissue is tight enough to be capable of holding them in place (since they are teardrop shaped the tissue has to be able to keep them from rotating, which could otherwise cause a deformity).

Before and After Rippling Photos

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  1. Rippling

    Her implants were supposed to have been behind the muscle, but the muscle was so damaged that there was none left to put the implant behind. Strattice was used to add coverage and keep what little muscle there was over the implants.

  2. Inferior Malposition (L), Rippling

    The left implant is lower than the right and the pocket was closed off. Her implants are still too wide for her, which is why they are so close together. Rippling is visible on the sideways photo, and this was helped by changing from saline to silicone.

  3. Rippling

    Her saline implants had a lot of rippling that could be felt. They were also in front of the muscle. Since she is so thin, silicone implants were placed behind the muscle, reducing her rippling and improving her appearance..

  4. Rippling, Wants Larger

    Her implants were too small and too wide apart. Her breast skin was not filled. A slightly larger ipmlant and removal of scar tissue gave her better cleavage, shape, and treated the rippling.

  5. Wants Larger, Rippling

    She is round and far apart, so it looks like a contracture. But it is actually a high profile saline implant (see rippling on side view.) Larger silicone ipmlatns were placed which improved her cleavage, shape, and rippling.

  6. Rippling

    Like most rippling patients, notice how thin she is. In reality some of her improvement may have been due to her gaining weight. Still, there is a significant improvement in the lower inner left breast from tightening the pocket and changing to silicone

  7. Rippling, Strattice

    Rippling is always worst when someone bends over. Note from her breastbone how thin she is (rippling is a problem of thinner patients.) Thickening the area with Strattice cured her rippling problem.

  8. Severe Rippling

    This patient had such large implants they thinned her tissue. And her muscle was damaged, so she lost coverage over the implants. Note the implant fold at 7 O'Clock on the right breast. Strattice was used to thicken the tissue and pull the muscle down.

  9. Rippling, Drooping

    If a loose and thin breast is underfilled, it will ripple. She was changed to silicone, but the real improvement came from doing a lift (scar is just barely visible on the outer breast on the lower right photo.

  10. Implant Removal, Rippling

    Her muscle was damaged at her first operation, so she kept having rippling and distortion after multiple attempts to fix. Strattice could have helped, but she just wanted to stop spending money on her breasts and put it behind her.

  11. Contracture, Rippling, Strattice

    Her implants were supposed to be behind the muscle, but the muscle was damaged which caused the upper inner rippling. Strattice reinforced the muscle and created enough coverage to stop the rippling.

  12. Rippling, Drooping

    This very thin woman originally had huge implants, which stretched her skin. She already had a lift with smaller implants, but the left was still low and she looked too round. Larger teardrop implants and a redo of the left lift helped her.

  13. Wants Larger, Rippling

    She had high profile silicone implants in front of the muscle which were too small for her. Going behind the muscle with a larger anatomic implant gave her a much more attractive shape and eliminated her rippling.

  14. Inferior Malposition and Rippling

    As her left implant slid down and out, the tissue over it became thinner and the rippling of the saline became more visible. The outer pocket was closed off, moving the implant inwards. Saline was changed for silicone.

  15. Rippling

    Significant upper inner rippling is visible on the right breast along with distortion of it. Her muscle had been damaged from previous surgery. Strattice was used to regain some muscle coverage and thicken her tissues.