What causes breast implant rippling?

There are several factors that cause breast implant rippling, and understanding them is important when assessing whether a complication has occurred within normal surgical risk, or whether it reflects a failure in surgical judgement.

Insufficient tissue coverage

One of the most significant contributors to implant rippling is poor tissue coverage. When there is very little breast tissue or skin to cover the implant, the edges and folds of the implant become more visible at the surface. People with very little breast tissue prior to surgery are at greater risk of this outcome, and surgeons are expected to discuss this risk fully during a breast augmentation consultation.

Implant type

Saline implants are generally more prone to rippling than silicone implants. This is because saline - the salt water solution used to fill them - moves more freely within the implant shell, creating more obvious folds. Silicone implants, particularly those using a cohesive gel, hold their shape more effectively and are less likely to ripple visibly. The choice between saline implants and silicone implants should be discussed carefully during the breast augmentation consultation, with the patient's anatomy and risk profile taken fully into account.

Implant placement

Implant placement plays a considerable role in whether rippling occurs. Implants placed above the pectoral muscles - known as subglandular placement - provide less tissue covering and are therefore more likely to result in visible rippling, particularly in patients with less existing breast tissue. Placement beneath the pectoral muscles generally provides greater cover and can reduce the risk of visible implant rippling. Selecting the appropriate implant placement for a patient's anatomy is a fundamental aspect of careful procedure planning.

Implant size

Choosing larger breast implants than are appropriate for the patient's frame and existing breast tissue can affect rippling outcomes. When the implant size exceeds what the breast envelope can comfortably accommodate, tension on the skin and tissue covering may make breast rippling more apparent. A surgeon who recommends larger implants without adequately assessing whether the patient's tissue can completely cover them may not be fulfilling their duty of care.

Weight loss

Significant weight loss following breast augmentation surgery can reduce the amount of natural breast tissue and skin surrounding an implant. When patients lose weight, less tissue is available to cover the implant, which can cause or worsen breast implant rippling that may not have been present - or may have been only minor rippling - at the time of the original surgery. This is a recognised risk factor that a surgeon should explain during the informed consent process.

Implant shape

Round implants and anatomically shaped implants behave differently under movement and pressure. Anatomically shaped implants are designed to mimic the natural slope of the breast and may be less prone to rippling in certain positions, although the evidence varies and implant choices must always be tailored to the individual. Round implants, while widely used with excellent results, may enhance fullness in the upper pole in ways that can increase tension on overlying tissue.

How is breast implant rippling treated?

Treating breast implant rippling depends on its cause and severity. For those with visible rippling that is causing concern, there are several treatment options available:

• Fat grafting: fat grafting involves transferring fat from another area of the body to add tissue covering around the implant. This can reduce visible rippling without requiring full implant revision. Fat grafting is considered a less invasive approach to correct breast implant rippling where the implant itself does not need to be changed.
• Revision surgery: in cases of significant breast implant rippling, breast revision surgery may be recommended. This could involve changing to a different implant type (for example, switching from saline implants to silicone implants), adjusting the implant placement, or replacing larger breast implants with a smaller implant to reduce tension on the breast envelope.
• Implant removal: in more complex cases, implant removal without replacement may be considered, particularly if the patient's tissue coverage is insufficient to support an implant without visible implant rippling recurring.

For most breast augmentation patients, revision surgery offers the most effective long-term resolution. Your plastic surgeon should provide a full assessment of the most appropriate approach based on your anatomy and the specific nature of the breast rippling you are experiencing.

Can breast implant rippling be prevented?

In many cases, yes. Preventing breast implant rippling is a key responsibility of the operating surgeon. Careful procedure planning - including selecting the right implant type, implant size and implant placement for the individual patient - can significantly reduce the risk of visible rippling. Surgeons should assess existing breast tissue and skin thickness thoroughly before surgery and avoid breast augmentation in patients where poor tissue coverage makes visible rippling a likely outcome, unless that risk has been fully explained and consented to.

Avoiding breast implant rippling through good surgical planning is not a guarantee, but patients are entitled to expect that their breast surgeon will make evidence-based decisions that take their specific anatomy into account.

When does breast implant rippling become a legal matter?

Not every case of breast implant rippling will give rise to a legal claim - it is, as noted, a recognised risk of breast augmentation surgery. However, there are circumstances in which implant rippling may indicate that a surgeon fell below the standard of care expected of them:

• The patient had very little breast tissue and was not adequately warned that visible breast implant rippling was a likely outcome
• Larger implants were selected without proper assessment of whether the patient's natural breast tissue could cover the implant adequately
• Implant placement above the pectoral muscles was chosen for a patient with poor tissue coverage without proper discussion of the increased risk
• Saline implants were recommended without exploring whether silicone implants or cohesive gel alternatives would have been more appropriate
• Informed consent was not obtained in relation to the specific risk of breast rippling for that patient
• Aftercare was inadequate and the patient was not referred promptly for assessment when rippling became visible

When a surgeon's decisions in relation to implant choices, tissue covering assessment, or surgical technique fall below the accepted standard, and this results in visible breast implant rippling that causes harm, that may constitute a breach of their duty of care. Cosmetic Surgery Solicitors is the first UK law firm dedicated exclusively to cosmetic surgery negligence claims, and our team - led by Michael Saul - has helped many people whose breast augmentation surgery did not meet the standard they were entitled to expect.

What compensation can cover

If your breast implant rippling resulted from avoidable harm caused by negligent surgical practice, you may be entitled to claim compensation. This can cover:

• The cost of corrective breast surgery or revision surgery
• Fat grafting or further treatment required to address the rippling
• Psychological support for distress caused by the outcome
• Loss of earnings where recovery has affected your ability to work
• Travel and treatment costs

Every claim is assessed individually based on the specific circumstances and the medical evidence available. Cosmetic Surgery Solicitors works on a no win, no fee basis, meaning there is no financial risk in making an initial enquiry.

How long do you have to make a claim?

In most cases, you have three years from the date of the procedure - or from the date you became aware that the outcome may have been caused by negligence - to bring a cosmetic surgery claim. Special rules apply in some circumstances, including for those who lacked mental capacity at the time of treatment. If you are unsure whether your time limit has passed, it is worth seeking advice as early as possible.