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Picture throwing a pebble into a pond. What happens? As the pebble disrupts the surface of the water, the water begins to create concentric waves that move away from the point that the pebble entered the water. Similarly, what happens if you drop the same pebble into thick mud or a bowl of honey? Well, nothing really happens. The reasons these two scenarios create very different outcomes has to do with the physical properties of the substance the pebble lands in. Is it a low viscosity fluid like water, able to create waves or is it thick and cohesive like the honey? I know this seems like a long-winded tangent, but bear with me as I relate this to breast implants.
Silicone Versus Saline:
The biggest physical difference between a saline and a silicone breast implant is what the implants are filled with. Both implants contain a similar shell, but the substances inside the implants impart very different characteristics to them. Silicone breast implants are made with a thick, cohesive gel that maintains its structural integrity with the natural movements of the body. It is because of this that patients often say silicone implants feel more natural than their saline counterparts. In addition, silicone implants are much less likely to develop ripples in their shells simply because the cohesive gel is much like the mud or honey described earlier– largely resistant to shape changes with movement and gravity. Conversely, saline breast implants are basically filled with physiologic water, and their low viscosity makes them much more subject to changes in shape with movement and gravity.
What is Implant Rippling & Why Do We Care?
Implant rippling occurs along the outer shell of the breast implant and looks much like those concentric ripples I described in the first paragraph. In certain patients, we worry about the possibility of being able to feel and even see this rippling, which would pose as an obvious giveaway to having breast implant surgery and go against the natural look most patients are trying to achieve. During my breast augmentation consultations, we discuss this in two specific contexts– when discussing the differences between silicone and saline implants, and when discussing how a patient’s specific anatomy will play into my recommendations for their surgical plan.
The Highest Risk Factors:
Patients at the highest risk for visible implant rippling are those who have very little native breast tissue and who desire a saline implant placed above the pectoralis major muscle (subglandular or subfascial pocket). This is because saline implants have a higher rate of rippling (as explained above), and the lack of implant coverage from either breast tissue, fat, or muscle make it more likely that rippling occurring on the implant shell will be seen or felt through the skin.
How Can We Prevent It:
Prevention of palpable or visible implant rippling can be done through proper implant choice, proper implant placement (pocket), or through the addition of procedures such as fat grafting to add additional implant coverage. It is important to point out that even with submuscular implant placement, rippling can still be an issue on the outer and inferior aspects of the breast. The picture below illustrates placement of a submuscular breast implant in relation to the muscle borders. You can appreciate that while the pectoralis muscle covers the majority of the implant superiorly, it does not fully cover the implant below or out to the side.
Where Do We Go From Here:
The most powerful tool you have as a patient is education and knowledge. Saline implants are a wonderful choice in many patients and shouldn’t be overlooked simply because they have the potential to ripple. I have treated many patients who are at a higher risk of rippling due to lack of native breast tissue, yet still choose saline implants for the peace of mind if a rupture were to occur. In these cases, patients have been given all the knowledge and tools, and have made a decision for themselves that aligns most with their highest priority goals. No breast implant is perfect and no surgery comes without risks. A thorough Plastic Surgery consultation should take you through all options and leave you with a strong understanding of why your chosen surgical plan is the best option for you.
Dr. Megan Dreveskracht is a Seattle-based Female Plastic Surgeon who specializes in Aesthetic Surgeries of the Breast, Body & Face. To schedule your consultation, call 206.860.5582 or fill out a contact form here.
