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Rippling or Wrinkling of Breast Implants

Although this is very disturbing to many patients, this is not really a complication or a risk, as rippling will occur with all implants. All breast implants has rippling or wrinkling to some degree.  Implants, whether they are saline or silicone are all susceptible to rippling – either palatable or visible.  The degree of rippling or wrinkling is based on several factors that work to help hide the rippling or factors that will contribute to this. 

 

 

Rippling happens when the filling material, either saline or silicone; inside a breast implants shifts and allows for a fold or a wrinkle to appear on the outer shell.  Unfortunately sometimes this shows up as a bump or a ridge – and can be felt and in bad situations, seen on the surface of the breast.  Silicone implants tend to have less rippling than saline, however even silicone is not exempt from this.  A lot has to do with whether the implants are placed over the muscle or under the muscle as well as the surface of the implant. Textured implants because of their ability to grab onto the tissue are more prone to rippling than smooth shell implants because of the fact they are more palpable. 

Silicone implants that are placed under the muscle will give the patient much better odds of rippling not to happen, especially in thin skin patients with little body fat.  The thickness and quality of the patient’s skin will determine the amount of rippling. 

 

Contingencies that Increase Wrinkling or Rippling in Breast Implants:

 

Contingencies that Decrease Wrinkling or Rippling in Breast Implants

  • Patients who have an adequate body weight and a thicker layer of fat

  • Patients should be at optimal weight if possible before the augmentation

  • Patients who start out with larger pre-operative breasts

  • Smaller implant size

  • Saline or Silicone Fill

  • Smooth surface implants

  • Fill ratio of saline implants is done to most optimal level

 

 

                                           

                  Photo of Implant showing "Scalloping Ripples" along the edges

 

 

 

Implants tend to ripple more near the cleavage (where the skin is thinner) and near the outside area towards the arm.  For patients who have “Partial Sub-Muscular” implant placement, and who have thin or non-existent tissue to start with, the bottom portion of the breast can also get some rippling.  Partial sub-muscular placement utilizes the pectoralis muscles with covering 2/3 of the implant.  This top 2/3 of the implant is hidden behind the muscle, making rippling or wrinkling less likely. 

Patients who have little to no tissue to start the breast augmentation out with are normally discouraged to having over the muscle placement, as there is no layer helping with hiding the implant edges.

 

 

 

Another factor that contributes to implants rippling or wrinkling is not utilizing the optimum fill rate of the device.  Sometimes in order to get the optimum fill rate, this will mean that the plastic surgeon will need to overfill the implant passed the manufacturer’s stated amount.  Overfill is the volume added to an implant that is more than the manufacturer's MAXIMUM limit

 

On all breast implant pamphlets it clearly states:

“Follow the recommendation on the product data sheet for fill volume; do not overfill or under-fill the implant”.

The difference between inadequate volume and the optimal volume is amazingly small, somewhere around 10%, which equates to only a couple tablespoons of water. 

Optimal fill helps the implants last longer, even though that may exceed the manufacturer's maximum, and of course it helps with wrinkling and rippling. It has been studied extensively that wrinkling of a breast implant can and does lead to premature failure by causing high stress folds and wrinkles.  The studies have confirmed that optimal filling by reducing the wrinkling can and does actually help the implant last longer.

Optimal Fill Ratio also targets too much “over-fill” in the saline implant.  Just like under-fill, overfilling too much can actually cause the implant edges to scallop (uniformed wrinkles all around the edge).

 

 

 

Although under-filling implants can give a much softer feeling to the device, there are some distinct drawbacks to this:

  • Implants lose durability and longevity because wrinkles can form and create a rupture

  • Upper Pole Fullness is less when the implant is under-filled

  • Wrinkling at the top of the implant happens

 

 

                                    

                                               Saline Implant that is Under-filled

 

 

 

 

 

Traction Rippling

 

  • How Traction Rippling Occurs

Textured implants were primarily designed to prevent the complication of Capsular Contracture.  There are many studies concerning this subject matter on whether or not the textured surface is really efficient in preventing capsular contracture.  Some studies have shown that implants that are placed under the muscle, there is no difference in the complication of capsular contracture rates, while others show a much lower rate of this problem occurring. 

Traction rippling is not considered a complication, rather a visible surface feature.

A textured surface implant, whether it is saline or silicone can produce traction rippling because of the manner in which the textured surface is incorporated into the surrounding tissue.  Implants can change shape or position due to changes in the body position.  Because of the phenomena that occurs with texture implants pulling the surround tissue (the capsule) – this can in turn pulls on the skin as it falls to the bottom of the pocket.  It is this pull that produces the traction rippling.

Only the use of smooth implants eliminates this risk.  

Traction rippling normally occurs on a thin patient that has little to no tissue and they might be able to feel the implant on the side.  Traction rippling has a uniformed pattern with how it appears through the tissue, and this can appear “wave-like”.

Traction rippling can occur with an implant over or under the muscle.  If the patient has partial sub-muscular placement, then the rippling may not be visible in the upper portion of the breast, but it will be noticeable on the lower pole area where the implant is only covered by tissue.

 

                                            

                                            Patient showing "Traction Rippling" 

                    Saline Under-filled Implants - Textured Surface - Sub-glandular Placement

 

 

 

 
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