Visible wrinkles at the cleavage or side of the breast are a coverage problem, not a defect — the honest mechanics, the fix ladder, and the planning that prevents it.
No implant is a rigid ball: shells fold microscopically, gel obeys gravity, saline sloshes. In a breast with generous natural tissue, millimetres of padding hide all of it. In a slim chest with a pinch-test of under ~2 cm, the soft-tissue curtain is thin enough for those surface behaviours to print through — classically at the inner cleavage, the outer lower pole, or when leaning forward. That's rippling: not a defective device, but honest physics meeting thin coverage.
Tissue thickness is the master variable — very slim, small-breasted patients start with the least curtain. Subglandular placement puts only gland and skin over the implant; behind-the-muscle routes add a muscular layer exactly where cleavage ripples show. Saline ripples more than cohesive gel (fluid folds harder), and an underfilled saline is the textbook rippler. Very large implants stretch and thin the curtain further — one more entry on the honest cost list of oversizing (the size-regrets article keeps that ledger). Modern form-stable gels were engineered substantially to shrink this problem.
Rung 1 — add coverage: structural fat grafting layers your own fat over the ripple zone — often the least invasive, most natural fix, especially for edge rippling with otherwise happy implants. Rung 2 — change the plane: subglandular ripplers move behind the muscle (dual-plane), recruiting the pec as living padding. Rung 3 — change the device: underfilled saline or older soft gels exchange for cohesive, appropriately sized modern implants — commonly combined with rung 1 or 2 in one revision. The right rung follows the cause: grafting fixes coverage, not a wrong plane; a new implant fixes physics, not thin tissue. Assessment sorts which is yours.
For thin-coverage anatomy the honest plan reads: behind-the-muscle placement, cohesive gel, moderate sizing, and pre-warned expectations ("you may feel the implant edge at the side — feeling is normal, visible rippling we plan against"). A consultation that pinch-tests your tissue and explains this trade-map before you choose is doing implant surgery properly; one that only shows you a size menu is planning your revision. Photos plus your pinch estimate via the free assessment get you the ripple-risk read before anything is booked.