Complications

Breast Implant Rippling: Causes and Prevention

UNE Plastic Surgery · Dr. Kim Uigeon, board-certified plastic surgeon · Published 2026-09-21 · Updated 2026-09-21

1. When rippling becomes a reason for revision

Rippling can lower satisfaction when it looks like waves on the surface or the implant folds are felt on touch. Mild cases are observed; severe cases are corrected with an implant exchange, a plane change, or fat grafting. The first three things assessed: where the rippling shows (upper breast, side, cleavage), whether it shows even when clothed, and how much it is felt on touch. Those three decide whether to only monitor or go as far as an implant exchange.

2. What rippling is and how it looks

Rippling is when folds form at the edge or surface of the implant and show through or are felt under the skin. A normal breast is a smooth line; with rippling, the edge looks as if it is undulating. Where it shows:

• Upper pole — most common in a lean body.
• Lateral (side) — rippling when lying on the side.
• Medial (near the cleavage) — with a large cc and a narrow base.
• Lower pole — in cases where ptosis has progressed.

Rippling is a cosmetic issue with no pain or functional problem. Still, it affects satisfaction and is easy to notice yourself, so it often needs a consultation.

3. Body types prone to rippling

A pinch test comes first: if the tissue is thin when pinched, any implant carries a higher risk of the edge showing — so in a lean body, this must be confirmed before surgery. Rippling is relatively more likely when these apply:

• A lean body with low BMI
• Insufficient upper-breast pinch-test thickness (under 2 cm)
• Glandular atrophy after childbirth
• A preference for a large cc
• A narrow base width
• Reduced skin elasticity
• A history of prior surgery (revision)

The combination of lean body + large implant + subglandular placement is known as the highest-risk mix for rippling — the case to watch most carefully. One or two factors are managed with standard prevention, but when three overlap, the implant line and placement are all reconsidered at the first-surgery stage.

4. The four causes

1. Insufficient skin and subcutaneous thickness: if the tissue over the implant is thin, the implant’s own folds show through. Most common in a lean body (BMI under 18.5) with an upper-breast pinch under 2 cm.
2. Low implant cohesivity: a saline implant or a low-cohesivity gel line is softer in itself, so folds form more readily. Saline implants have the highest rippling rate.
3. Subglandular or subfascial placement: a position where the pectoralis does not cover the implant, so in a lean body the rippling shows directly. Dual plane or subpectoral placement lets the muscle cover the upper implant and hides rippling.
4. Large cc relative to base width: an implant too large for the base makes the implant bulge at the edge, so edge rippling stands out. The High Five system emphasizes choosing a cc matched to the base width (Tebbetts & Adams, Plastic and Reconstructive Surgery, 2005).^[1]

5. Rates by implant, position, and body type

Rippling rates differ consistently by implant type, placement, and body type.

In practice, a lean body with saline placed subglandularly is the highest-risk combination; conversely, a fuller body with a high-cohesivity gel in a dual plane is among the lowest. (Actual rippling is decided not by the implant line alone but by skin thickness, placement, implant size, and body type together. Available implant lines differ by country; this describes lines available in Korea.)

6. Four-step prevention

1. Consider dual plane first: in a lean body, dual plane is the standard recommendation — the pectoralis covering the upper implant hides rippling naturally. By Tebbetts’ classification, Type I/II/III is set to the breast type (Tebbetts, Plastic and Reconstructive Surgery, 2001).^[2]
2. Choose a cc matched to the base width: after a pinch test and base-width measurement, decide within the recommended cc range. A cc slightly smaller than the target lowers rippling risk further.
3. Choose an appropriate cohesivity line: a lean body suits a mid-cohesivity line; saline and very soft lines can raise rippling risk.
4. Smooth surface first: smooth implants are mainly used in Korea; textured implants are seldom used because of BIA-ALCL risk (Adams et al., Plastic and Reconstructive Surgery, 2017).^[3]

7. Correcting rippling that is already present

Mild (not visible when clothed): observe. It can be covered in daily life with a support garment or pad, and can look more natural as swelling resolves.

Moderate (edge folds visible even when clothed): options include exchanging the implant for a higher-cohesivity line, changing the placement from subglandular/subfascial to dual plane, or reducing the cc to one matched to the base width.

Severe (edge clearly felt and seen): implant exchange + plane change + fat-grafting reinforcement — grafting autologous fat to the upper breast to increase the tissue thickness over the implant. Given a graft take of about 50–70%, more than one session may be needed. Correction is best decided after full consultation, and faithfully following the four prevention steps at the first surgery is the way to reduce the burden of further surgery.

8. What to confirm in consultation

Good things to ask: how many mm your tissue thickness is, which plane is recommended at that thickness, and how the rippling risk is judged for that combination. Once those three are answered, the rest follows. Items to confirm with the medical team:

• Pinch-test thickness — upper-breast skin plus subcutaneous tissue
• BMI and body-type assessment
• Base-width measurement and recommended cc range
• Implant line — balancing cohesivity and the feel you expect
• Placement — dual plane first for a lean body
• Expected rippling risk, clearly explained
• Correction options if it occurs, explained in advance

Rippling is a complication where prevention beforehand is far more efficient than correction after. A thorough assessment at consultation is the key.

Summary

• Rippling is more frequent with a lean body, saline, and subglandular placement. Risk is high when at least two or three of the four causes overlap.
• Prevention is four steps: dual plane + appropriate cc + a mid-cohesivity line + a smooth implant.
• Rippling already present is corrected with implant exchange, plane change, and fat grafting — but prevention at the first surgery is far more efficient.

References

1. Tebbetts JB, Adams WP. Five critical decisions in breast augmentation using five measurements in 5 minutes: the high five decision support process. Plast Reconstr Surg. 2005;116(7):2005–2016. doi:10.1097/01.prs.0000191163.19379.63.
2. Tebbetts JB. Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types. Plast Reconstr Surg. 2001;107(5):1255–1272. doi:10.1097/00006534-200104150-00027.
3. Adams WP, Culbertson EJ, Deva AK, et al. Macrotextured breast implants with defined steps to minimize bacterial contamination around the device: experience in 42,000 implants. Plast Reconstr Surg. 2017;140(3):427–431. doi:10.1097/PRS.0000000000003575.