So, from a patient point of view, there are really two things that drive people crazy with breast implants. The first one is capsular contractions, which in not what we’re going to talk about. The other thing is ripples, which we are going to talk about at length. Ripples are inherent in soft implants. If you lay down, you implant is nice and smooth. But when you stand up, it’s going to get some ripples and folds in it. If your tissue is so thin that you can see those ripples right through your skin, that’s when it becomes a problem.
That’s also the main reason that implants go in behind the muscles. The pectoralis muscle edge is right here. If you want to see it, stand in front of the mirror. Put your hands like this, go like that, and you can see that fold. Just draw a straight line down. But what that tells you is that this part of the implant is under muscle. This part is not. Even in an under muscle placement or submuscular placement, half or a third of the implant is out from under the muscle. So if you are really, really thin, if you can see your ribs over here, you’re going to see ripples. That’s just the nature of lack of coverage.
Now, I’ve been asked more than once, “If I work out, build up the muscle, am I going to have less ripples?” And the answer is yes. If you get thicker muscle up here, you have less chance of having ripples up here. But there’s no muscle cover over here. So, working out doesn’t help this. Added body fat, which nobody wants to do, is really about the only solution to that, or you can use more cohesive implants, that are some of the form stable implants. There are ways to minimize the ripples, but for the most part, that’s where they come from and if you are just that thin, you’re going to have ripples.