Aesthetic Plastic Surgery

, Volume 43, Issue 2, pp 305–312 | Cite as

High- and Extra-High-Profile Round Implants in Breast Augmentation: Guidelines to Prevent Rippling and Implant Edge Visibility

  • Antonio Carlos AbramoEmail author
  • Marcio Scartozzoni
  • Thiago Walmsley Lucena
  • Romulo Grechi Sgarbi
InnovativeTechniques Breast Surgery



Rippling and implant edge visibility after breast augmentation depends on several factors. Among the most relevant are breast soft tissue thickness, particularly the retroareolar mammary parenchyma, and implant profile. They were correlates to prevent these occurrences.


Thirty patients underwent breast augmentation through subfascial dissection involving the pectoralis, serratus, external oblique, and rectus abdominis fascias. The thickness of the retroareolar mammary parenchyma distributed patients into two groups. Group I: patients with thickness equal to or greater than 4.0 cm received high-profile 85% fill round implants. Group II: patients with thickness up to 3.9 cm received extra-high-profile 100% fill round implants. MRI was performed preoperatively and 5 years after augmentation to evaluate breast tissue changes and implant contouring.


Seventeen patients with high-profile implants and thirteen patients with extra-high-profile implants had noticeable improvement of the breasts without the occurrence of rippling or implant edge visibility. A natural appearance of the breast, increased mammary cone, balanced upper and lower pole contouring was maintained at 5 years postoperatively. MRI performed 5 years after breast augmentation validated patient clinical outcomes not evidencing implant deformities, or soft tissue thinning, parenchymal atrophy or chest wall deformities.


The adequate correlation between retroareolar mammary parenchyma thickness with high-profile 85% fill and extra-high-profile 100% fill textured round implants was of utmost importance in preventing rippling and implant edge visibility. The wide fascial support, width of the implant smaller than the breast diameter, and soft cohesive gel-filled implants were co-adjuvant factors in preventing rippling and implant edge visibility.

Level of Evidence IV

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


Rippling Implant edge visibility Breast augmentation High-profile round implant Extra-high-profile round implant MRI 



“To the cadavers of selfless dedication”.

Compliance with Ethical Standards

Conflict of interest

No financial support or benefits have been received by the author or any co-author to accomplish this manuscript.

Ethical Approval

All procedures performed in this study involving humans participants were in accordance with the ethical standards of the ACA - Institute of Assistance in Plastic Surgery of São Paulo research committee and with the 1964 Helsinki Declaration and Medical Research Involving Human Subjects and its latter amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  • Antonio Carlos Abramo
    • 1
    Email author
  • Marcio Scartozzoni
    • 1
  • Thiago Walmsley Lucena
    • 1
  • Romulo Grechi Sgarbi
    • 1
  1. 1.Post-Graduate Course of Plastic Surgery, ACA - Institute of Assistance in Plastic Surgery of São PauloBrazilian Society of Plastic Surgery and Brazilian Medical AssociationSão PauloBrazil

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