Breast implant wrinkling – What causes it and how to reduce risk?

Modified on | by Dr. Ricardo L. Rodriguez

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.

Factors that contribute to breast implant wrinkling

There are several factors which contribute to visible breast implant rippling. The most common factors are:

  1. Type implant: saline, gel silicon, or gummy bear silicone
  2. Amount of coverage of the implant by your own soft tissue cover (skin, breast gland, fatty tissues)
  3. How much of the implant is placed under the muscle

Type of Implant affects wrinkling

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.

saline implants are the most likely to show wrinkling – Dr. Rodriguez

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 amount of tissue that covers the implant affects 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.

Breast Implant placement– under the muscle avoids implant wrinkling

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.

If you have any questions please post them below!

(originally published August 2, 2009)

Wondering if a Breast augmentation is right for you?

Contact Us to schedule your in-office or virtual consultation. Or just give us a call at 410-494-8100! Note: Virtual consults can also be used to get second opinions.

By Dr. Ricardo L. Rodriguez MD Board Certified Plastic Surgeon Cosmeticsurg Baltimore, Maryland Ricardo L. Rodriguez on American Society of Plastic Surgeons.

Related categories

Related procedures

Leave a Reply

Your email address will not be published. Required fields are marked *

100 thoughts on “Breast implant wrinkling – What causes it and how to reduce risk?”

  • Gerli says:

    I have had implants placed and now 8 months later, big wrinkles are visible. Since I had implants placed under the muscle, do pectoral muscle exercises help to get rid of wrinkles?

    • Dr. Ricardo L. Rodriguez says:

      Placement under the muscle only helps wrinkles that are on the upper pole of the breast. If the wrinkles are in the lower lateral pole of the breast or in the medial part of the breast you have several options. 1) Switch to a higher density implant. It will be firmer, but it will wrinkle less. 2) You can place an absorbable mesh to wrap around the breast at the area of wrinkling 3) My preferred option would be fat grafting as it makes your sin a little thicker and firmer, thus less likely to show wrinkling. If you are interested in further information, call the office at 410 494-8100 for a virtual consult

  • Nataliya Thomas says:

    I am almost 40 years old .10 years ago I did breast augmentation with saline implants moderate profile Allergan 600cc.last 2 years I started having rippling on the sides,especially my right breast, so I went for a consultation with 4 doctors they all said I am not a candidate for saline anymore. Long story short. 1 month ago I did a surgery ,changing my saline implants for allergen silicon soft touch 685cc HP. 1 week after surgery I could tell I have rippling. Both breast but the right breast is worth. Now I even noticed that I get ripples in my cleavage..I went to my doctor, he said nothing he can do ,u have 2 choices take them out or live with rippling. (Sorry it was very emotional for me, I hate looking at my breast, even at home I wear a sports bra..just not to see those horrible ripplings.) I did read a lot about rippling and that u can use matrix reconstructive tissue but its stupidly expensive . My doctor said I am super skinny.. that I don't have a lot of body fat. I am 150 pounds, I am very fit..but not skinny. . I Don't know what to do and what doctor to go.. Thank u very very much ..looking forward to hear from you . .

    • Dr. Ricardo L. Rodriguez says:

      Sorry for the delayed reply. We were redesigning our website and some of these comments were not visible. You do have an option- Fat grafting. The fat grafting should be properly performed- see elsewhere on my website the sections on proper fat grafting. Most important is small particle size and injection in the right tissue plane. Dermal tissue matrices are also an option, but they are under review presently with the FDA. I think they are good option, but frankly I prefer fat grafting- it"s your own tissue.

  • Dahlia says:

    Hi doctor, I viewed your video and i have a question. Im 3 years now post BA of high profile. 250 cc cohesive gel implant that was inserted inframmamry with subdual plane i have performed mri a week ago and there was a bit of lateral herniation on my left implant i started seeing visual rippling at the sternum with certain animation my implant in supine position rides to the axila a bit plus its a bit harder then the right one I wanted to know am experiencing muscle seperation from the sternum and if so is there any imaging to show that, mri ruled out thuck capsule bit could i have a rather tight one but not thick my surgeon does not recommend to go under the knife again unless we use alloderm support or i can live with it but the thing is i see the rippling

    • Dr. Ricardo L Rodriguez says:

      Dahlia: Your case is complex and I would really need to do a virtual consult to be able to give you specific advice. Contact Kelly at kelly@cosmeticsurg.net if interested. Bu right off the bat, if you don't want to go inside again, there is the possibility of fat grafting to thicken the skin cover and mask the defect. Surgically there are other options like elevating the lateral border of pectoralis minor, anterior serratus, and origins of external oblique. This forms a muscle "sling" that supports the breast in the lateral and inferior poles. It also masks rippling.

  • April says:

    I got the gummy bear implant under muscle two years ago and now i have rippling on the side next to my other breast. Like where my cleavage is...why? Is something wrong?

    • Dr. Ricardo L Rodriguez says:

      April: The gummy bear implant is not a guarantee against wrinkling, it just makes it much less likely. Another reason is if your skin cover is very thin you can see very minor imperfections. A less invasive form to take care of this problem might be fat grafting to the area to create a thicker skin cover that masks imperfections.

  • Maria Caccamise says:

    I sat in the sun in a sundress but the sun was so strong that my implant wrinkled through the dress i am 4 week post op. Wili it heal??

    • Dr. Ricardo L Rodriguez says:

      Maria: I doubt the sun had anything to do with it. Most probably the swelling went down after a month, which is quite common. The wrinkling is not going to disappear, I'm afraid. It has several solutions such as fat grafting, changing to a different type of implant, or placing the implant in a different plane.

  • SHERYL says:

    HI Great presentation, I am wondering I had a 130 pound weight lose and do have saline implants, I have no fatty tissue their and im noticing a very lot of wrinkling on the side and under neath. could exercise and building of the Pec major and minor make this go away? or do I need new implants/ they are about 15 years old, signed desperately wrinkly

    • Dr. Ricardo L Rodriguez says:

      Sheryl: There are many options for you. First there is the cohesive gel implant which is a very coherent gel that resists deformation. We could also do fat grafting around the implant. We can help you many ways. Contact Kelly at kelly@cosmeticsurg.net and she will get you more information.

  • Patricia Jacobs says:

    I had double mastectomy 2 years...ago... 73 Have this rickling.... What can be done about it?? Had the salene ... Think maybe skin is too fat... Wanted C size and they did D do not like it... To old to go thru It again ... But does this ever happen... Breast are just yo big for me.. Only 5 ft 2 so mad???

    • Dr. Ricardo L Rodriguez says:

      Patricia: I am sorry about your experience. But let me try to answer some of your concerns. Yes, this does happen occasionally. A Saline implant is not ideal for implant reconstruction. A better option would be a "gummy bear" type of firm silicone implant that does not ripple. Skin is not too fat, if anything it is too thin. About implant size, a redo is not going to be nearly as painful or traumatic as the original surgery.

  • Candace says:

    Can you exercise to build better muscle tissue to cover beast implant wrinkles? I had breast reconstruction after breast cancer and 15 years later needed to have the implants replaced. I opted to reduce the implant size by 100 cc. I now have vertical wrinkles that resemble stretch marks one month after the surgery.

    • Dr. Ricardo L Rodriguez says:

      Candace: You need fat grafts done by somebody who does a lot of them and does them reliably. The grafts will thicken the skin layer. You cannot do this with exercise. There are also implants with a firmer silicone that will not wrinkle.

  • Christine says:

    I just had gummy bear implants, last weds. No swelling. I have very thin skin. I had radiation on the right side, there is some wrinkling already, however, I get a sharp pain right in the center of my breast bone everytime I lay down, everytime. I is more towards the side of the wrinkling. What could be causing that pain?

    • Dr. Ricardo L Rodriguez says:

      Christine: The pain is either due to the muscle insertions of the Pectorals muscle, or due to an intercostal nerve stretching. Let your surgeon know of this problem.

  • Esther says:

    I had a breast reconstruction in the month of August 2015 after a mastectomy in the month of February 2015. Now I have a complication with Memory Gel breast implant. I have wrinkling and I am very uncomfortable, you can see trough out my blouse or dress the wrinkling . Tell me what is the solution for this embarrassment and discomfort I'm appreciate your help. Thank you Esther

    • Dr. Ricardo L Rodriguez says:

      Esther: Because the skin flaps tend to be very slim after a breast reconstruction, wrinkling is always a risk, even with the use of Memory gel implants. Fortunately, fat grafting can solve the problem by thickening the skin envelope over the implant. Contact Kelly at kelly@cosmeticsurg for more information.

  • shai says:

    am a transgender pinay(filipina).my silicon implant is 2yrs now.i have 400cc.but i notice wrinkling in my other side of my breast.my skin is thin.i ask my doctor if possible 500cc in my skin.he said no..and ask what kind if surgery to remove my injection on my face.i want my face look pretty & natural

    • Dr. Ricardo L Rodriguez says:

      Shai: Both your questions are not simple and I need more information to answer adequately. If you want an in depth discussion you can set up a virtual consult with Kelly at kelly@cosmeticsurg.net

  • gemma says:

    Hi I am getting Implants in few weeks and was wondering what is the best position to put them on top of the muscle of behind I have read that much I am confused I am slightly worried about it rippling and mammograms so am pushing toward under the muscle I am 32a and petite up top I would greatly appreciate your advice please. Thanks Gemma

    • Dr. Ricardo L Rodriguez says:

      Gemma: I have not examined you and know very little about your case. You should have this discussion with your surgeon. If you do not feel confident of your decision you should ask him again. If the answer does not satisfy you then I suggest getting another surgeon.

  • shannon says:

    I got silicon gummy bear implants. my right one looks like it is sagging and smaller then lef . I got them 4years ago in march

    • Dr. Ricardo L Rodriguez says:

      Shannon: I would love to help you but this is very little information to go on. You can contact Kelly at kelly@cosmeticsurg.net if you want to provide us more information so we can give you an educated opinion about your options.

  • Lyne flaherty says:

    Dear Dr Rodriguez, Thank you for your video! It is very clear and informative. Nine years ago I had breast implant surgery : two years ago I started feeling a small lump on the lower cleavage side of my left breast. I was very concerned and thought it was somehing I should address immediately. The mammogram came out normal...the plastic surgeon who performed the surgery just told me it was nothing without even feeling the lump. Now I have more wrinkling on the same side and it is bothering me. I can " feel" the lumps when I move or breathe besides of course touching them. It is not hurting but cumbersome ...I did lose much weight in the past year and I was already thin before. You mentioned thin skin and thin women. Is there anything I can do to reverse or stop it from wrinkling even more? I know it is a long post. I am sorry...thank you!

    • Dr. Ricardo L Rodriguez says:

      Lyne: Sorry about the delay in answering. What you are saying does sound like implant wrinkling. You have two choices, substitute silicone implants if you don't have them already. The second choice is to inject fat into the area. Fat injection is a technically challenging procedure but very effective when done correctly. Contact Kelly if you have any questions. kelly@cosmeticsurg.net

  • Ashanti1 says:

    I had breast implants 3 1/2 years. And have over the last 3-4 months noticed obvious rippling. I have always been a petite person, but was advised to have the implants on top of the muscle. I had a child who will be 2 in feb. I went back to My surgeon who told me this was due to my pregnancy/loss of breast tissue. he said that I should have had the implant under the muscle and to correct this I would have to have a new implant behind the muscle and an uplift. Is this is a fault of the surgeon for not advising me properly or a fault of my pregnancy?

    • Dr. Ricardo L Rodriguez says:

      Ashanti: There are a lot of changes in the breast after pregnancy, with loss of volume. So it is very possible that after pregnancy the appearance of a breast implant would change, specially if you are petite and the implant is over the muscle. I would recommend getting several opinions before you settle on a surgeon. You may not need an implant replacement if you like the size you are now. You may also consider the possibility of fat grafting to the breast. Hope this helps! If you have any further questions please contact Kelly at kelly@cosmeticsurg.net

  • grateful says:

    continuation of the below message.I forgot to mention I do have silicone implants (not gummy bear) under the muscle. I know its not sure if under the below muscle.

  • grateful says:

    I had a bilateral mastectomy 4 weeks ago it was a skin sparing with nipple grafting. My nipples are starting to get better they were black, however some of the black is dropping off with fresh skin underneath. My question is I am starting to see rippling in the lower portion around and below my nipples not at the top I was wondering if the rippling would dissipate once I am totally healed. I am thinking that the rippling maybe caused from the stitches around my nipples and incisions below I would like to know what your thoughts are?

    • Dr. Ricardo L Rodriguez says:

      It probably is the implant. You have to wait some more to see once the capsule is all formed around the implant. Ask your surgeon. It is only 4 weeks after the fact, so a lot can happen. Later on when all is healed you may try some fat grafting.

  • Sue says:

    Hi I hope you can help me i have had implants in 2005, they have ruptured and rippiling, I went bk to the surgeon who did my operation and he said he can replace them bit cannot get rid of the rippiling he said it may look ok for a couple month but then it will rippiling again, I asked of it could go under the muscle and he didn't seem to like the idea of it he was from transform medical group he told me his the best plastic surgeon and no other surgeon can help, pls can I help or give me some advice

    • Dr. Ricardo L Rodriguez says:

      Sue: You have MANY surgical alternatives. The surgeon can place them under the muscle, there are products like Alloderm that can be placed over the implant, etc. We would be happy to help you. I see you are from the UK, we have had several patients from UK. If interested, email Kelly at kelly@cosmeticsurg.net Hope this helps!

  • Dalia says:

    Dr. Rodriguez I am currently 4 months post op, cohesive gel, under the muscle. Today after a shower I noticed ripples above my breast, toward the middle. Once I massaged it, it totally disappeared but if I ran my fingers up my chest it came back as if I was pulling my inner skin upward. What may be the cause of this?

    • Dr. Ricardo L Rodriguez says:

      Dalia: Ask your surgeon. It is unusual for an implant to show wrinkling in the upper pole when it is under the muscle. If you stand naked chest in front of a mirror and clasp your hands together and press against each other you will see your pectoralis muscle get hard. This should flatten the implant. If it does not, the implant may not be under the muscle.

  • Paulina Carlos says:

    Hi Dr Rodriguez Three Weeks ago I had breast augmentation below the muscle using round silicone implants to correct tuberous breast. Now I'm starting to feel wrinkles in the lower pole of both of my breasta and I wonder if it's due to three absence of glandular tissue, or due to a defective implant, and if in any case it'd correct by itself or should I need fat injections because I have no tissue down there. I'll appreciate your answer. Regards.

    • Dr. Ricardo L Rodriguez says:

      Paulina: Most surgeons elevate only the Pectoralis muscle when they say "below the muscle", indeed, it is the "standard way" of doing it. I elevate the origins of the external oblique and the rectus abdomens which are in the lower part of the breast precisely to avoid the problem you are having. In your case I would wait a good 4 months and if the wrinkling is still evident, I would strongly consider fat grafting for the lower pole of the breast. Check out our blog, we have plenty of information on fat grafting- how to get long lasting results, about the high content of stem cells in fat grafts, and many others.

  • maria says:

    GOOD MORNING DOC. MY NAME IS MARIA CASTALDO. I AM A STUDENT OF BIOMEDICAL ENGINEERING. MY THESIS REGARDS WRINKLING OF BREAST IMPLANTS. CAN YOU TELL SOME LITERARY TEXT FROM WHICH TO OBTAIN INFORMATION? THANKS!

    • Dr. Ricardo L Rodriguez says:

      Maria: I'm not sure what kind of information you want. Is it clinical? or is it about the implants themselves? If it is about implant and silicon viscosity and compliance characteristics the best resource is the implants manufacturers themselves. What got you interested in this subject?

  • debbie says:

    hi, ive had more troble with my implants, i had my 3rd op 2.5 years ago, the first op i had bad rippling, my second op they ruptured and this time there rippling again, ive had them done behind the muscle all 3 times and this time ive had euro silicone. ive lost 1 stone ans since then my breasts have started rippling, im not going to loose any more weight so do you think they get any worse. im sick of operations and im covered in nasty scars now, i feel more self contience no than i ever was before i had my first implants. will excersice on my chest help, many thanks debbie x

    • Dr. Ricardo L Rodriguez says:

      Debbie: There are many reasons for rippling in the skin overlying the breast implant, as you can see from our blogpost. There are two or three things you can do at this point. One is to add an extra layer of tissue using one of the newer dermal substitutes, such as "Alloderm". The other one is to add fat grafting to the area, to thicken the skin cover over the implant. The third alternative is to elevate the capsule that formed over the implant together with the muscle on the lower lateral part of the chest and place the lower part of the implant under this "muscle sling". All this can be done using the previous scars so you won't get new scars. The fat grafting leaves scars that are so small you won't notice them. We'd love to help you, give us a call!

  • Judy Dueck says:

    Hey I have wrinkling or rather rippling on the in the cleavage of my breast implants. I came to the conclusion that it was caused by my massage that the Doctor prescribed to me. Only instead of using the palm of my hand i used my fingers. Now my breasts have rippling like finger marks. I have been trying to massage to get rid of them. Do you have any suggestions? Judy

    • Dr. Ricardo L Rodriguez says:

      Judy: The wrinkling is most probably not due to the massage. There are several various causes, including pectorals muscle insertions into the chest wall, to the implant itself, he content of your body fat, etc. I would consider fat injections to the area, or placing an alloderm sheet inside the implant pocket. Talk to your surgeon. If you have no luck, contact Kelly at kelly@cosmeticsurg.net to see if there's any way we can help.

  • kristina says:

    hi,i did my surgery in ireland 9 months ego,and i have breast implant rippling.i meethink my doctor today in 5 hours,just wondering,is tghis is doctor foult that i have this thinks.thank you

    • Dr. Ricardo L Rodriguez says:

      Kristina: Rippling has many causes. Was your implant saline or silicone? Was it placed above the muscle or below the muscle? Sometimes, even if the surgeon does a procedure perfectly you can get rippling. There are solutions available like fat grafting, or changing implant type or placement.

  • Jessica says:

    Hi Dr. Rodriguez, I am 11 days post op, silicone under the muscle 397cc implants. I am thin and I had next to no natural breasts to begin with. Since the very beginning I had noticed what appeared to be a small "dent" in my right breast, I wasn't too concerned about it but now the dent has turned into ripples in both of my breats in the cleavage area. I am really upset about this but trying not to get too worked up because I realize I am still early in the recovery process. Do you think this might correct itself once they are fully healed, is there anything I can do to make it better? I would really appreciate an answer to this!! Thank you so much

    • Dr. Ricardo L Rodriguez says:

      Jessica: I do not know how your surgeon did the procedure, so I cannot provide details about what is happening. I do know that 11 days post op is too soon for any judgements. In my own practice I don't even reoperate until 4 months have passed. This may resolve itself, but if it doesn't, there are things that can be done to make it better. Finally, you should have a long discussion with your surgeon and ask him whether the implants are above or below the muscle, what he thinks is going on, etc.

  • angela mcclean says:

    i have an implant that has moved out off place it has totally changed shape it looks like half an implant nd the other implant is very wrinkled they have both went dwn in size dose this mean i have to suregery to fix it

    • Dr. Ricardo L Rodriguez says:

      Angela: Are the implants saline? If so deflation is a possibility. How long ago was the surgery done? If recently, it is possible you are seeing the final results coming into focus. Were they above or below the muscle? You should talk your surgeon and find out more answers. If you are interested, we could set you up for a virtual consult to be able to give you a better opinion. You can contact Kelly at kelly@cosmeticsurg.net.

  • lori mador says:

    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.

    • Dr. Ricardo L Rodriguez says:

      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.

  • Kim M. says:

    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!

    • Dr. Ricardo L Rodriguez says:

      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.

  • Wendy says:

    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

    • Dr. Ricardo L Rodriguez says:

      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!

  • Helen says:

    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

    • Dr. Ricardo L Rodriguez says:

      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.

  • Sara W says:

    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

  • LINDSEY says:

    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

    • Dr. Ricardo L Rodriguez says:

      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!

  • Rose Hann says:

    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.

    • Dr. Ricardo L Rodriguez says:

      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.

  • Rose Hann says:

    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

  • Rose Hann says:

    I thank you. I wish you were in Connecticut. I will let you know the outcome. Many thanks, Best regards, Rose

  • Rose Hann says:

    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.

  • Rose Hann says:

    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

    • Dr. Ricardo L Rodriguez says:

      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

  • Rose Hann says:

    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?

    • Dr. Ricardo L Rodriguez says:

      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.

  • Rose Hann says:

    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.

    • Dr. Ricardo L Rodriguez says:

      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.

  • Liz says:

    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.

    • Dr. Ricardo L Rodriguez says:

      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

  • kelley robinson says:

    So does this technique increase the risk of muscle contracture? Also how does this affect the woman who lifts weights? Thank you.

    • Dr. Ricardo L Rodriguez says:

      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!

  • D says:

    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?

    • Dr. Ricardo L Rodriguez says:

      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!

  • lidiya says:

    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!

  • lidiya says:

    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!

    • Dr. Ricardo L Rodriguez says:

      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.

  • lidiya says:

    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!

    • Dr. Ricardo L Rodriguez says:

      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.

  • lidiya says:

    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!

    • Dr. Ricardo L Rodriguez says:

      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.

  • Yve Burns says:

    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!)

    • Dr. Ricardo L Rodriguez says:

      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!

  • Sylvia Gomez says:

    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?

    • Dr. Ricardo L Rodriguez says:

      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.

  • Carmen Moreno says:

    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

    • Dr. Ricardo L Rodriguez says:

      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.

  • Carmen Moreno says:

    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!

    • Dr. Ricardo L Rodriguez says:

      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.

  • fort myers breast implant says:

    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.

    • Dr. Ricardo L Rodriguez says:

      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.