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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
Board-Certified Plastic Surgeon
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47 Comments
February 2, 2012 at 10:43 pm
Lori:
There are several reasons why this could be so.
First of all, the “gummy bear” implant reduces the incidence of wrinkling, but an implant would have to be almost solid to prevent wrinkling if a capsule contracture is severe enough.
Secondly, other things such as partial muscle attachments could also give the appearance of wrinkling.
Finally, after a mastectomy, the soft tissue coverage is minimal so any implant deformation will show through.
In any case, without seeing or examining you, all one can do is guess.
There is a solution, of course, which would be to inject fat to the soft tissue coverage. This would give the breast a smother appearance and actually soften things up. Call Kelly at kelly@cosmeticsurg.net if you are interested.
January 29, 2012 at 9:51 am
How would you explain rippling in one breast only (on inner and outer sides) after bilateral mastectomy followed by gummy bear implants under the muscle?
Thank you very much.
December 19, 2011 at 10:17 pm
Kim:
It really is too soon to give any advice. I make my own patients wait 4 months before we start discussing revisions. Usually by that time most problems have sorted themselves out.
The use of a bra after surgery depends a lot of the surgical technique used. I myself sometimes use a bra, other times a band above the breast which pushes the breast down, etc.
It all depends on the individual case.
If you have so many questions postoperatively, you should write them all in a piece of paper, demand to see the doctor, and go over each of the questions until you have all of them answered to your satisfaction. If the doctor refuses to see you or will not spend time with you, you will need to see a doctor who can examine you in person.
December 10, 2011 at 2:53 am
I am also having the same issues. I had replacement surgery 3 weeks ago and went from saline implants to silicone implants. Both times the implants were under the muscle and with the saline implants I didn’t notice any wrinkling but now with the silicone I am experiencing a wrinkle on the outer left breast. I mentioned this to my surgeon 2 days after my surgery and he told me it was to soon to jump to conclusions. Could he of done something at that time to fix the wrinkle? I am also experiencing pain when I touch the breast where the wrinkle is, is this normal? Why do some surgeons say to wear a support bra right after surgery and some surgeons say not to wear one for 3 weeks and after the 3 weeks only wear one when absolutely needed? I notice that the wrinkle don’t hurt as much when I do wear a bra, should I wear it more often? Will it help with the wrinkle? I am so confused and have many unanswered questions. I could really use some advise! Help! Thank you!
November 15, 2011 at 7:09 pm
Wendy:
The intercostal nerves come in between the ribs right on either side of the breast bone. It is possible that the nerves have gotten stretched with the stretch on the skin from the implants, but this is only a guess. I only say this because when you lay on your side and it pushes the implant to stretch those nerves it seems to make matters worse.
Your PS suggestion to take Motrin (Ibuprofen) is well founded as sometimes low grade inflammation around the nerves can cause these types of pain, and an antiinflammatory such as Motrin can help.
Another medication that can take care of inflamed nerves is Neurontin. I use it occasionally on patients who get intercostal nerve related pain.
Finally, Physical Medicine and Rehabilitation (“Physiatrist”) Doctors are very good at sorting out these issues.
Hope this helps, and spread the word about my blog!
November 13, 2011 at 1:47 pm
Hi, I have saline Implants around 320cc. They are under they muscle. I have had them for almost 5 years now. Since mid September of this year I have had what started out as discomfort around the top of my right breast and went over towards the left side of it which also made it uncomfortable for me to lay on my right side because it put pressure on it and pushed the implant more into that left corner. I went in to see my PS. He did a very short exam in which he said he saw no evidence of scar tissue and that THEY looked perfect and to take Ibprofen for two weeks and that my mysterious symptoms should go away just as they came. Well, they have worsened. It has now spanned out through my entire breast and the discomfort has become almost unbearable. I have seen my regular Dr about it. She Sent me to have an Ultrasound where they found nothing and referred me back to my PS. I’m getting nowhere, and the pain is only getting worse. Besides the Ibprofen, I have been doing ice packs and heat. Any type of pressure or bumping like my arm touching/bumping is extremely painful. Any suggestions on what it could be?
Thanks
September 2, 2011 at 1:16 pm
Helen:
Whether the implant moves or not will depend on how the muscle end attaches to the breast implant capsule.
given the fact that you have wrinkling and motion with muscle movement, I would recommend a revision. It does not necessarily mean the implant needs to go under the muscle totally.
fat injections may also help, as well as disrupting the attachment of the muscle to the capsule.
We would love to help you, contact Kelly at kelly@cosmeticsurg.net if you are intrested.
August 31, 2011 at 5:31 pm
hallo. i have partially under the muscle 225cc and gel implants and hade rippling under the breast and on the side. I some time don´t like the feeling that my breast moves when the I use my breast muscle. So now I wonder if I put the implant completly under the muscle do the movement get worse or will it be the same? Thank u!
Helen
July 18, 2011 at 4:41 pm
I have Saline implants 325 cc. I have had them for almost three years and have very noticable rippling on both breasts. Is there anyway to fill the bags post surgery to reduce wrinking without having to get new implants altogether? Or what is my best option as of now for fixing the visible and tangible wrinkles? Thanks so much for your time.
Sara
April 17, 2011 at 10:56 am
Lindsey:
You have 4 choices
1) Placement under the muscle elevating the serratus anterior and origins of the external oblique muscle to provide lateral coverage
2) Placement of Alloderm patch over area where you have rippling.
3) Fat injections to the breast areas where you have rippling
4) A combination of 2 or more of these choices.
If you are interested in a virtual consultation so I can see pictures of the defect and make more specific recommendations, contact Kelly at kelly@cosmeticsurg.net, we’d be happy to hear from you!
April 12, 2011 at 6:15 am
Dear Dr Rodriguez
I have had revision surgery last april due to visible rippling, they put in 440 gel implants slightly overfilled so firmer and they are over the muscle, i do not have alot of my own breast tissue as i am quite slim. I still have visible rippling, is there anything you could suggest?? I do not know where to go from here, is it possible to put under the muscle now?? would that maybe solve it? or do you have any other ideas?
thanks for your comments.
Lindsey
March 18, 2011 at 12:36 pm
Rose:
Going thru the axilla would be very difficult indeed.
Has he considered the inframammary fold? That is the fold underneath the breast.
In any case, if he goes thru the old scar, you will not have a new scar. The redone scar will also fade in time.
Be persistent, there is an answer somewhere.
March 17, 2011 at 10:09 am
Dr Rodriguez,
Thanks for all your advice. I have a question my PS says too difficult to do. We discovered the lateral muscle near axillary was moved with heavy lifting and the revision surgery will go through mastectomy scar. I had nipple/areola reconstruction and scar from mastectomy nearly gone. I would like to know if this can be done through axillary? I don’t want a longer new scar since the healing is done.
Thank you for your time.
March 11, 2011 at 12:43 pm
Dr Rodriguez,
I am going to Yale, but more importantly I discovered by accident what the problem is.
Lateral muscle was detached when I lifted a propane tank. I was kneeling down and saw it. Showed my PS, he agreed, but I will still get 2ND opinion. Just because they are implants and I am thin does not mean they can’t be what I want them to be. Will have more lipo fat graft also.
Thanks,
You are a gem
Best regards, Rose
March 10, 2011 at 10:59 pm
Rose:
Used to be at Yale!
March 8, 2011 at 11:33 pm
I thank you. I wish you were in Connecticut. I will let you know the outcome.
Many thanks,
Best regards,
Rose
March 8, 2011 at 10:31 am
Rose:
I wish you the best and I will pray for you.
March 7, 2011 at 9:00 pm
Thank you so much for your great advice. My daughter is a friend to this new PS I am going to see. I will have every question answered. The journey from mastectomy to reconstructive surgery was made easy with my PS by my side. I am heart broken he cannot figure a way to help me, hence I am seeing a stranger.
Thank you again. I will let you know if the new Doc can fix it.
March 7, 2011 at 2:05 pm
Rose:
Do not be wowed by a “world renowed PS”. Ask him all the questions you want, do not leave the office until you feel he has completely answered your questions, and make sure he will be personally available to you in the post operative period.
Best wishes
March 6, 2011 at 10:54 am
Thank you Dr. Rodriguez for your response I found out my PS does not do pocket adjustments. Again he is concerned with symetry. I suggested we adjust both, but he doesn’t know how to proceed.
I have an appointment with a world renown P S. I have not been pleased with the outcome, so perhaps I should look at this as a blessing. I have an appointment 3/24/2011. I will let you know the outcome.
Rose
March 6, 2011 at 1:36 am
Rose:
At this point, you should seek a second opinion.
The second surgeon may agree or disagree with the first, but at least you will be better informed.
February 24, 2011 at 9:01 pm
Thank you Dr. Rodriguez for your response. I have discussed this at length with my PS. He doesn’t hear the part about feeling a pop while lifting. My right implant from August 2010, to present has loosened significantly. He said “they are implants”. I had a bilateral mastectomy and know they are implants, but, they can still look great. I want to have the breast that make me happy. My PS claims it will change symmetry. Is that true? I have been in pain since last August, not exactly the distraction I need after breast cancer.
I try to remain positive, but I am afraid if this man does not agree with my opinion of what caused this, what else can I do?
February 24, 2011 at 4:47 pm
Rose:
Since this happened 3 weeks postop, you should discuss this with your surgeon, He’s the one who knows how he placed things, and should be able to give you guidance.
No matter what, keep your hopes up, because implant adjustments can be made, and it is not as complicated a procedure as you may think.
February 20, 2011 at 9:45 am
I have silicone implants after tissue expansion. About three weeks pot-op I was in a squat position lifting a propane tank. I felt a pull which left the upper part of tissue numb and resulting in lying on my back the implant falls far to flank area, on either side it pulls hard falling on top of the left and the other side pulls and lays on my mattress beneath me. I tie a scarf under one implant and over the other for comfort. I have constant discomfort in that upper area of implant. I feel hopeless and frustrated implants will move side to side permanently.
Please, If there are suggestions how to correct this, I will be grateful to read them.
December 4, 2010 at 2:24 pm
Liz:
If the muscle has been totally separated from its insertion at the cleavage, then no matter how much you work out the muscle, it will not have an effect.
At this point, the only things that may help are gaining some weight, or having a second procedure to do some fat grafting to the area, or adding material such as alloderm to the medial breast capsule.
We would love to help you. You can contact Kelly at kelly@cosmeticsurg.net, she’d
November 8, 2010 at 10:28 am
I had saline implants under the muscle and about a year and 7 months post op I started feeling the rippling. My surgeon suggested swapping with silicone implants, so 2yrs2mos after 1st BA I underwent another BA and switched to silicone. I am only 6 days post op and I already see 1 or 2 ripples by the cleavage on the same breast from before. I watched your presentation and was wondering if I could work out my chest muscles, once healed, to help mask the visibility? I am a small patient, 105 lbs, and breastfeed both my children so I believe I would be considered to have less/soft tissue coverage. I REALLY want to fix this, especially the visibility. Thank you for your time.
July 29, 2010 at 9:46 pm
Kelley:
Although muscles do contract, what is referred to as a breast implant contracture has nothing to do with the muscle. The capsule that forms around the implant (or any foreign material in your body) is formed by some cells called myofibroblasts and collagen. These myofibroblasts can sometimes become hyperactive and contract the capsule too much.
Lifting weigths can help as the muscle contractions massage and stretch the capsule. On the other hand, if you are a competitive body builder it is not a good idea to place the implant below the muscle because the massive muscle contraction will distort the implant.
Hope this helps!
July 29, 2010 at 9:20 pm
D:
We do plenty of conversion procedures. Over the muscle implant placement looks good for a few years then it behaves like a regular breast: it goes south. Under the muscle implants generally don’t do this because they are held by a capsule that is attached to the muscle.
The decision to do a lift depends on the position of the areola. If the areola is low, then we do a lift. If the areola is high in relation to the breast implant, then we may not need to do a lift.
In any case, we can handle the lift using only a periareolar scar.
We’d love to see you, so drop Kelly a note at kelly@cosmeticsurg.net.
Have a great summer!
July 21, 2010 at 6:08 pm
So does this technique increase the risk of muscle contracture? Also how does this affect the woman who lifts weights? Thank you.
July 18, 2010 at 12:34 pm
What about converstion procedures? Where a patient has implants subcutaneously and then opt for submuscular. I’m sure there is loose skin; how is this dealt with? (given the same size implant)
Do you do a lift? …and what type(s) of lift(s) do you use?
July 7, 2010 at 11:25 am
hello! anyway thank u for answering! do not know what to do with them…i’ll wait when i’ll be able to go to the usa, cause here i think they wouldn’t be able to fix it, although our doctors are good too,may be they just don’t know the tichnique that you use! may be we’ll see each other if God’ll give! have a good day!!!!! thank u!
July 1, 2010 at 11:11 pm
Lidiya:
If the implants move to the side, it’s very typical of an implant that is under the pectoralis muscle. It may still not be covered by muscle at the distal or lateral edges.
When the pectoralis muscle is still attached medially at the sternum, as it contracts, it flattens, pushing the implants out toward the side of the chest wall. Since there is no muscle coverage laterally to hold it, the implant is free to slide out.
June 29, 2010 at 2:44 pm
Hello from Kazakhstan!!!! thank u so much for very fast reply! i know that if muscle works, it moves implant….. when i went to ultrasound and doctor told me that my implant stays over the muscle, i told her that it is impossible, cause 1) i asked both surgeons to place the implant under the muscle, 2) when i work with the musles, imlants go away to the different sides of the chest. but she told me that implants are stuck to the muscle that is why they’re moving and she showed me on the monitor musle,implant and breasts tissue itself.and added that implant is over the muscle.
what if the imlants under the muscle and the ultrasound made a mistake, do i have to accept the appearance of my breast,and there is nothing to do about them, to make them look better?
i would gladly have come to visit you, i’m planning coming to states, but don’t know when,may be not even this year….it is very hard to get the usa visa, and my american visa is already expired.
thank u a lot for answering all our(patients) questions !!!! have a great day!
June 29, 2010 at 8:10 am
Lidiya:
As I said in my previous post, this is how most surgeons do an “under the muscle” breast augmentation. That is, the pectoralis muscle only covers the upper part of the implant.
Wrinkling near the middle of the chest wall could either mean: a)-that the implant is under the pectoralis but the attachments of the muscle at the center are unevenly detached. Where the muscle is still attached, it forms a wrinkle depression. Where the muscle is detached it shows an implant bulge. b) The implant is over the muscle, and all the implant imperfections are visible.
There is a simple way of seeing the difference.
Stand in front of a mirror and put both palms of your hands together as if you were in prayer. Press both palms together hard. This will make the pectoralis muscle contract. If the implant is above the muscle its appearance will not change. If the implant is below the muscle, the contraction of the muscle will deform the implant.
Let me know how things work out.
June 29, 2010 at 8:01 am
Lidiya:
You need to see a board certified Plastic Surgeon. Before you see him get all the pertinent information. This includes the operative dictations from the first two surgeries as well as a copy of the ultrasound itself and the written reading of the ultrasound. If possible, get copies of your preoperative photographs before the first and second surgeries.
This is not a simple case, and a well qualified surgeon has to see you in person. It is very possible the pectoralis muscle is covering the upper part of the implant but not the medial, lower, or lateral parts. This is why I elevate the muscles in the lower and lateral parts of the breast. Not everybody does this.
I wish you the best, and keep me posted.
June 23, 2010 at 11:19 am
i forgot to say that i can not only see the wrinkling, but i can also feel them and feel the implants’ sides in low part of the imlant. is that possible if implant placed under muscle( as my doctor insists). after 1st op i don’t remember feeling the edges.
thank you!
June 23, 2010 at 10:02 am
hello! i’ve had my first surgery abt 3 years ago. 290cc,round bio implant, high profile (11cm,proj 4,8), under the muscle. but i didn’t like the rezult (assymetria, narrow round implant, which was bad for my chest type(i have athletic body).
one year ago i had a baby, and 2 month ago made my 2nd surgery. 325 cc almost 13 cm width, anatomic form, very soft cohesive gel. passport says it is low profile(5,1 proj). so, i like the last result better except visible rippling on the both breasts on the side which is closer to the center of the chest ( right where is a gap between two breasts). when i had 1st op implant was placed under the muscle, doctor who made 2nd op confirmed it and said that he placed new implants on the same place. but 2 days ago i went to ultrasoud and it showed these whrinkles and that implant stays over the muscle. i think that this is the reason why i see these ripples on my breast.i had ripples after 1st op but it was on different place (a lot of peole have them there,closer to armpits) and i was ok with that. but i comletely don’t like to have them right in the center of my chest. they killing me,i’m very much upset abt them.
so, how can i solve my problem? can ultrasound show for sure where implant is placed. do i need to have another op.
i know it was complicated,but i hope that you understand me! thank you a lot!
April 25, 2010 at 8:27 am
Yve:
If the ultrasound confirms the diagnosis of a wrinkle I would leave it alone.
Many people have wrinkling of the implants, it is more common than you think.
Enjoy your implants!
April 22, 2010 at 3:14 pm
I had implants done last fall. The left one had what I thought was a lump in my breast — on the bottom. It moves and actually feels like the edge of the implant. My plastic surgeon said it was probably a wrinkle. I can feel it and it moves. I had my OBGYN check it and she said it does not appear to be a lump, but probably an implant wrinkle. I am having an ultra sound next week to be sure. My question is this — if it doesn’t show (at all) and is just a wrinkle, should I just leave it alone and know that they look good? Or should I have the plastic surgeon go back in and straighten it out? I guess since they all wrinkle somewhat and it doesn’t show, I have answered my own question, haven’t I? (I don’t like the way it feels when I do my massage. It freaks me out somewhat. But it looks great!)
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.