Rippling Following Breast Augmentation or Reconstruction: Aetiology, Emerging Treatment Options and a Novel Classification of Severity

Background Implant rippling is a frequent complication following breast augmentation or implant-based reconstruction and results in significant patient dissatisfaction. Traditionally, the treatment has been to replace the implant, often placing it in a subpectoral pocket to reduce the risk of recurrence. Other techniques, such as increasing the implant size or tightening the capsule, can also be used. Recently, however, there has been much interest in alternative treatments, including fat grafting or insertion of an acellular dermal matrix. Methods We review the evidence base for emerging treatments and propose a classification to grade severity, based on the typical clinical presentation of rippling: Grade 1—MILD—rippling is palpable but not visible: (1a) palpable in the lower outer quadrant, (1b) palpable in the upper inner quadrant (cleavage area); Grade 2—MODERATE—rippling is visible only when the patient bends forward; Grade 3—SEVERE—rippling is visible with the patient upright. Conclusion Our proposed classification aims to standardise the clinical description of rippling, which will be valuable in determining the efficacy of new treatments and better characterising long-term complications from breast augmentations or reconstructions. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .