How to prevent a waterfall deformity?

Question

Looking for some advice. I had a consultation with a plastic surgeon and was informed that a lift and an implant in the same surgery would not be suitable for me. The doctor had concerns that if both operations were done together this would result in a possible waterfall deformity, and it would be safer to wait 6 months after my lift. I am a 30 year who lost 45 kg, has poor skin integrity, and has 2 grade ptosis. Is my surgeon's advice correct? how do you avoid a waterfall deformity?

Connie Hiers, MD, FACS · Answer

Your surgeon is probably giving good advice. With your initial weight gain, you stretched and thinned your own tissue. With weight loss, you are left with thin and stretched out tissue that does not hold well.  Your breast lift is dependent upon this tissue. Doing the lift first, tightening your skin, and removing the excess, then following in 6 months with implants is usually best advice. Otherwise, your own tissue will start sagging. Waiting for scar tissue to form to help hold up your breast is best. When you do choose implants, do not go large and heavy.  When implants are placed, you also may need an internal bra for added support.

David P. Rapaport, MD, FACS · Answer

Hello,

A breast lift (mastopexy) combined with augmentation at the same time is one of the most challenging procedures that we perform as plastic surgeons. It's probably safe to say that if patients didn't mind doing the procedure in two stages, three months apart, we would always do it that way - the problem is that most patients do want to have both components performed at the same time. It seems the surgeon you went to is being very honest in stating his preference, and this is probably based on his own experience.

If it's very important for you to perform this as a single procedure, you should of course seek out a second opinion with a local board-certified surgeon and see if they have any additional insights to provide you. I wish you the best of luck in your journey.

Mark Hanikeri, MBBS, FRACS · Answer

Hi there

It is difficult to answer this question without photographs or a face to face consultation.  The waterfall or snoopy dog deformity occurs when the implant stays high on the chest but the soft tissues drop over the top of it allowing the nipple to sit below the most projected part of the breast.  It is more common with stretchy, heavy tissues and a round sub muscular implant.
Weight loss patients have permanently stretchy tissues so if you have sufficient volume you will be prone to the problem with round submuscular implants.

Waiting for your breasts to settle after a a lift makes the procedure safer from the point of view of blood supply to the nipple but also allows the tissues to relax more before putting in the implant .  This might influence where the surgeon sites the implant to reduce the risk of the deformity.

You should trust your surgeon if they are a specialist Plastic Surgeon or get a second opinion via a face to face consultation.

Good luck

Dr Mark Hanikeri MBBS FRACS
Perth Specialist Plastic Surgeon

How to prevent a waterfall deformity?

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