Rippling is an aesthetic complication that can occur after a breast augmentation. Every type of breast implant will ripple except highly cohesive silicone breast implants. So what is rippling? If you look at this clip, when an implant is vertical, gravity and the cohesiveness of the implant filling material tend to deform the implant. When the implant is in the breast pocket, the interactions between the implant and the soft tissue cause traction, and the ripples of the implant can be seen through the skin. For example, if you look at this patient, when she is leaning forward you can see the rippling phenomenon. This is most often visible in patients who have very little soft tissue covering the implant.This patient has a silicone breast implant above the muscle or in the subglandular plane. Let me explain this to you. If you look at this diagram, the implant lies above the muscle. The red arrow is the pectoralis muscle, and the implant, the white arrow, is on top of the muscle. This is a perfectly acceptable way of doing a breast augmentation, but the risk of rippling is higher than if the implant is placed under the muscle.In this particular patient, the implant must be replaced with a newer implant placed under the muscle. In this diagram, you can see what I am planning to do. The implant will be located under the muscle. The muscle is shown with the red arrow and the implant with the white arrow. The muscle will provide an extra layer of soft tissue coverage to minimize the risk of rippling. Most rippling occurs close to the cleavage line or the top of the breast. In addition, she wanted to be slightly larger, so I switched the implant from a 400 cc silicone smooth implant to a 500 cc silicone gel implant.These are pictures of the patient after surgery; you can see that there are no ripples when she is leaning forward. The patient is happy with her results.