All breast implants used in the breast augmentation procedure have a risk of creating some amount of wrinkling. Wrinkling is the effect which can make the skin look like it has ripples. This occurs in a small percentage of cases, and the risk can be reduced if the surgery is planned well.
There are several factors which contribute to visible breast implant rippling. The most common factors are:
- Consistency of the implant: saline, gel silicon, or gummy bear silicon
- Your own soft tissue cover (skin, breast gland, fatty tissues)
- how much of the implant is placed under the muscle
In terms of potential to wrinkle, saline implants are the most likely to show wrinkling, because they are the most flexible. Gummy bear implants are firm and are the least docile, so they are least likely to show wrinkling.Pick up an implant by the edge and you can see that the implant will make lots of folds. Silicon implants are less likely to ripple compared to saline implants due to the thicker density and viscosity of the silicon. However, they too, can create wrinkles. Gummy bear implants are very dense and thus the least likely to create visible ripples. There is to be a price paid because they may feel stiff. In cases with thin soft tissue cover, such as very thin patients or post mastectomy reconstruction, gummy bear implants are the best solution to prevent visible wrinkling.
The skin, breast tissue, and fat surrounding the implant is your soft tissue coverage. That also plays a role in the potential for visible wrinkles. The thinner your skin and the less fat you have, in general the greater chance there is for the implant wrinkles to show through the soft tissue cover.
Placement of the implant below the muscle is an important factor to control visible implant rippling. The technique of ’below the muscle’ as is commonly referred to, is actually a partial insertion under muscle (pectoralis major) of the top part of the implant. Over the years I have modified that technique so that the implant is covered by muscle at the top AND lower lateral half of the implant. This requires a little more dissection and time, but I have found it to reduce rippling.
Watch my video to see my illustrations of exactly how I insert the implant. If you have any questions please post them below!
Ricardo L Rodriguez, MD
Baltimore, Maryland
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8 Comments
October 18, 2009 at 2:31 pm
Your weight loss is the most likely reason that you are now seeing implant wrinkling. You probably always had the wrinkling, but now that the soft tissue cover (your subcutaneous fat layer) is thinner, the wrinkles are more apparent.
The best way to fix this is to switch the placement of the implant from above the muscle to below the muscle. If you are thin, you may be concerned that the wrinkles will show on the side of the implant. The way to prevent this is to make sure the implant is covered by muscle inferiorly and laterally by elevating the pectoralis minor muscle lateral branches, the distal insertions of the serratus anterior muscle, and the origin inertions of the external oblique muscle. Not many surgeons do this, but I think it is well worth the effort. I can only think of one patient in the past ten years that I have done where the wrinkles show.
October 18, 2009 at 1:18 am
My question is that I got breast implants about 5 years ago over the muscle with silicone and have noticed wrinkling in one of my breasts only. The one that it is noticed in is the smaller breast because I have one bigger than the other. I have also lost some weight since I first got my implants could weight loss be the cause of the wrinkling? Ive always been really petite and I weigh about 110 lbs but at that time I was a little bit heavier. Ive noticed the wrinkling since I’ve lost weight but am not sure this is the cause. What can I do to fix this? I’m going to have them re done so how can I prevent this from happening again?
October 2, 2009 at 10:29 am
Thank you for your kind reply.
At this point it is impossible for me to give any further advice without knowing more specifics about the case. If you want, we could schedule a virtual consultation after we receive pictures, a more complete history, etc. Contact Kelly at kelly@cosmeticsurg.net if tou are interested.
September 29, 2009 at 9:57 am
Thank you very much Doctor Rodriguez for your soon reply, you are really professional. Well, regarding my case this second time the implants were indeed placed under the top part of the muscle, they are round silicon implants McGhan. Only one breast is showing serious rippling. This is the fourth week after my surgery, the doctor tells me to wait and be patient, but in my own experience as time goes by and inflammation along with, the rippling seems only more evident. The doctor tells me as well that the skin has a ‘memory’ and they are probably the same wrinkles I had after my first surgery over the muscle. To be honest, im a bit skeptical about this theory, since otherwise I will have rippling in both breasts, not only one. I asked the doctor if it could be some kind of assimetry in my muscles, but he told me everything looked normal at the time of the surgery. After reading your reponse and doing further research I went to see my doctor and a second one to ask about solutions, I requested the fat injections or the dermal grafts, but they say they do not practice these techniques because of the secundary effects they have seen in patients, according to them fat injections is not a good option at all. So in short, they dont leave me any option but to wait around 18 months in my actual state to see if I can go through a second revision and see what they can do for me, since my tissues are just recovering for a surgery and it is not advisable to cut again. Now, indeed I feel hopeless. It seems I was not a good candidate to have implants in the first place. I relied on my muscles since I am an sporty woman and I thought my pectoral muscles would have enough volume to cover the implants, but looking at my implants it could look as if I had only one muscle and not two. I wonder if one of them could’ve moved out of place. I dont know it is one of my theories, though anyways I had to wait more than a year to be revised. If you could tell me what you think Doctor, I would appreciate it very much. Thank you in advance, and congratulations for your blog, it does clarify many doubts about plastic surgery. Have an excellent day.
Carmen
September 24, 2009 at 8:48 pm
You may have had a type of under the muscle placement where only the top part of the implant is covered with muscle, as this is the most common type of “subpectoral” placement done.
Don’t feel hopeless, as there are multiple options available, including fat injections, or placement of acellular dermal grafts, or even revision with elevation of the lower muscles to cover the lower portion of the implant.
Feel free to contact Kelly at kelly@cosmeticsurg.net to set up a virtual consultation.
We’d love to hear from you.
September 22, 2009 at 4:48 am
Doctor Rodriguez, I went already through two implant surgery. On the first one, it was over the muscle, and since I’m skinny, I presented serious rippling, this is why I had a second surgery, this time under the muscle to avoid the rippling, however I presented already wrinkles in my right breast, I wonder if it is due to lack of tone in my right muscle which is supposed to be covering it like in my left implant, or I wonder if during, or after the surgery it possibly moved to the top, exposing my implant. I dont know if it’s worthy going for a third surgery! I just feel helpless about my chances with breast augmentation. Thanks in advance for your reply and information. Have a good day!
August 10, 2009 at 5:36 pm
Implants always ripple, the problem is when they become visible.
I find that giving the extra muscle cover protects some thin patients from a high risk of visible wrinkling. I get some patients that have palpable, but not visible wrinkling, and I think if they had not had the muscle sling they would have had visible wrinkling.
August 10, 2009 at 4:23 pm
There will always be a chance for breast implant rippling. If the procedure is done in the manner that both the patient and surgeon agree upon, I think the end results will stay positive.