When someone says “Pucker up, baby,” it certainly shouldn’t refer to your breast implants.  Puckering, rippling or wrinkling is an uncommon but known complication after breast augmentation.

All implants have the possibility of creating wrinkles or ripples, usually along the outer edge near the underarm. The simple fact is that when something is inserted into your body, the risk of being able to feel or even see its shape does exist.

In breast augmentation, the goal is to achieve increased volume without being able to detect the edge of the implant.  Aesthetically, it’s better if wrinkling or rippling can be eliminated or made less obvious, because this will give a more natural result.

Luckily, there are several ways to reduce your chance of getting rippling or wrinkling after your breast augmentation procedure.

Choose Silicone Breast Implants
Opt for Under Muscle Placement
Don’t Be Really Thin
Don’t Go Too Big
Develop More Muscle
Use ACDM –  Acellular Dermal Matrix

Choose Silicone Breast Implants

Silicone implants feel and look more natural and will reduce your risk of rippling or wrinkling. The consistency of silicone is thicker and more dense than saline, which is just like water.

Think of it this way. If you filled one balloon with the same substance as a Gummy Bear (a fresh, soft Gummy and not an old, stale one that’s been sitting on the store shelf for months) and one balloon with water and then squeezed them, the Gummy  balloon would feel more “human-like” than the balloon filled with water. This thicker consistency reduces the risk of rippling or wrinkling. So simply by choosing silicone over saline implants, you can reduce your risk for complications from wrinkling.

Opt for Under Muscle Placement

Under the muscle, or submuscular, placement of your breast implants will lower your risk of rippling or wrinkling.  This is simply because more tissue is covering your breast implants. You’ll have skin, breast tissue and muscle,  not just skin and breast tissue, on top of the implant, which will reduce the likelihood of being able to detect the edge of the implant.

Some plastic surgeons place the implant on top of the muscle, but under the fascia –  the tough, slightly clear covering of the muscle.  This is sort of “in-between” in terms of reducing rippling and wrinkling.  Sub-fascial placement of the breast implants will be better than just under the skin, but not as good as under the muscle.

Don’t Be Really Thin

Here’s the easy part. Don’t be too skinny.

If you are really thin, you may still be able to feel or see the edge of your breast implant, even with silicone breast implants placed under the muscle.  This is very rare, and typically someone this thin will have visible abs and be pretty thin everywhere else.

If you are naturally lean, then you may be at risk for possibly feeling or seeing the edge of your breast implant, especially in areas of your chest that don’t have that much pectoralis muscle coverage, like the sides of your breast implants  just under the underarm areas.

The pectoralis muscle is pretty thick at the top and in the middle near the sternum. It becomes thinner at the bottom of the breast.  It is very thin to non-existent on the sides of the breast.  This explains why if you’re going to feel or see the sides of the breast implant, it’s typically going to happen at the sides of your breasts.

Develop More Muscle

In general, the average woman has plenty of muscle to cover a breast implant and have little chance of rippling or wrinkling.  However, if you are a complete weakling, or if you naturally have small  pectoralis muscles in certain areas or if you have a rare medical condition such as pigeon chest/ pectus carinatum or Poland’s Syndrome, then you may simply be genetically prone to having less pectoralis muscle in certain areas than the average woman.

While no plastic surgeon seems to advocate doing more push ups or hitting the gym for bench presses to develop more pectoralis muscle, in theory, it may help.

Use ACDM-  Acellular Dermal Matrix

Finally, recent advances using ACDM have helped to reduce rippling and wrinkling.  First used in wound healing plastic surgery reconstructive procedures, like breast reconstruction after radiation therapy,

ACDM can be used in breast augmentation cases to help cover areas and “thicken” the tissue that is overlying the breast implant.  The downside to ACDM is that it’s relatively expensive.

ACDM is dermis, the underlying structure of skin, that is harvested from cadavers (alloderm) or dead pigs (strattice).  It comes in thin sheets, which are opened in the operating room, and the sheets are placed in areas where the breast implant is rippling or wrinkling to cover up the problem area..

So, as you can see, there are many ways to reduce your risk of  breast implant rippling or wrinkling, which range from the simple choice of implant to the expensive additional surgery.

Please talk to your plastic surgeon about your options.  If you want to make an appointment with me, please contact Caroline, my Patient Care Coordinator, at or 415-362-1846.


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