Rippling, Malposition, Bottoming Out: Why Revisions Happen

Rippling is visible or palpable wrinkling of the implant surface, most often along the inner or outer edge of the breast. It tends to occur when there is thin tissue covering the implant — common in slender patients — and is more noticeable with implants placed above the muscle. The implant itself is usually intact; the issue is coverage, not failure.

Corrective options aim to add coverage or change the implant. Surgeons may move the implant to a plane under the muscle, graft the patient’s own fat over the thin area, or exchange the implant for one with different fill or form. Which combination makes sense depends on tissue thickness and the pattern of the rippling, and it is weighed case by case.

An implant sits inside a surgically created pocket, and over time that pocket can stretch or shift. Malposition describes an implant that has moved too far in any direction — sideways toward the armpit, inward toward the midline, or upward. Bottoming out is the downward version: the lower pocket stretches, the implant descends below the natural breast fold, and the nipple appears to point up while the lower breast looks overly full.

Contributing factors include tissue laxity, implant weight, the original pocket dissection and time itself. The standard repair is capsulorrhaphy — using internal sutures to tighten and rebuild the pocket wall — sometimes reinforced with supportive matrix or mesh material when the tissue is weak, and often paired with an implant exchange to a size the tissue can carry.

Revision timing matters. In the first months after augmentation, swelling still shifts how the breasts look, so surgeons generally prefer to let tissues settle before judging a result — many issues raised early soften or resolve on their own. Established malposition or bottoming out, by contrast, does not correct itself, and progressive stretching can make later repair more involved, which is why persistent changes deserve an evaluation rather than indefinite waiting.

Revision surgery is generally more technical than a first augmentation, and it carries its own possibility of side effects — recurrence of the malposition, scarring, infection and sensation change among them. The recovery period is often similar to or slightly longer than the original surgery, with support garments and activity limits while the rebuilt pocket heals, though the course differs by individual. Whether to revise, when and with which technique are questions for a consultation with a board-certified plastic surgeon who can examine the tissue firsthand.