Anne Peled

Rippling and Flipping Implant Questions Answered

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There are many mysteries and misconceptions around breast implants, but two of the most common questions that have been coming up lately in my practice are rippling and flipping. 

Rippling

Rippling describes seeing the folds of the implant through the overlying mastectomy skin (in reconstruction) or breast tissue (in augmentation). It can happen with either saline or silicone implants, though it tends to be more pronounced with saline implants. More cohesive/”gummier” implants are less likely to ripple because they hold their shape better in the body and are firmer, so the implant folds are less prominent. Although rippling is talked about more frequently in discussions of over-the-muscle reconstruction, it can happen with either over-the-muscle or under-the-muscle reconstruction.

When rippling occurs, several different approaches may help improve it. Switching out implants to more cohesive implants can work well. Sometimes, implants may also need to be exchanged for larger ones to help fill out the skin envelope better, which can reduce the appearance of rippling. Putting in a biologic mesh that will help stabilize the implant and/or add a little thickness to the tissues can also help. And finally, fat grafting may also be an effective option for some women to help camouflage the rippling by adding volume to the tissue over the areas of rippling.  

Flipping

Implant flipping (or malrotation) is often thought of as a potential complication of shaped/teardrop implants, occurring when the pocket was too large for the implants, giving them room to rotate clockwise or counter-clockwise, thus distorting the breast shape. More commonly, now, though, is the issue of front-to-back flipping, which happens most frequently with larger, higher-profile/projecting gummy implants. The basic thought is that the implants are essentially top-heavy, and in certain positions (typically when women are lying on their sides sleeping), the pocket opens up in such a way that the implant has room to flip over on itself. This complication is usually instantly apparent to women because the back/flat part of the implant is now facing forwards. When this happens, it gives the breast a flattened appearance with loss of roundness, seen particularly in the top part of the breast. The edges of the implant may also be more prominent or even visible.

Since gummier implants can be very helpful for minimizing rippling and helping with breast shape (particularly in reconstruction), the trade-off of potential intermittent implant flipping may be worth it in some cases. When implant flipping does occur, it can usually be fairly easily flipped back by women themselves, typically by leaning forward and making space for the implant in the pocket to allow for manual flipping back into place. 

If flipping is occurring frequently and becoming bothersome, revision with pocket correction and possible implant exchange may be needed to fix the issue.

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