Waterfall deformity? Do I need a breast implant reduction? (photo)

Your nipples are a little low on the breast mounds. The most reliable treatment would be to do a breast lift. Sometimes this can be corrected by repositioning of the implants. To provide the proper recommendation would require a physical examination. I would suggest beginning by discussing your concerns and options with your surgeon.

Thank you for your question. You appear to have symmastia (breasts merging in the middle) and a waterfall deformity (the natural breast tissue sags over the implant, making it appear too high while the breast tissue droops below it). You’ll need a revision surgery that includes implant exchange to a subfascial plane with smaller, lower-profile implants, combined with a breast lift to address sagging tissue and improve nipple position. A lift is essential to address the sagging breast tissue and correct the waterfall deformity. The subfascial plane avoids the muscle pushing the implants upward. Downsizing the implant will reduce tension on the breast tissue and minimize the risk of recurrent sagging or symmastia. Your surgeon will need to close the medial pocket to prevent the recurrence of symmastia. Consult a surgeon specialized in breast revisions to develop a personalized plan for your goals.

You made just need a lift to place the nipple-areola complex over the new breast mound. If you upload pictures of the photos prior to implant placement that can potentially help clarify what happened.

Dear Eclectic734297,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Hello and thank you for your question
Based on your photographs, I agree that you do have bilateral waterfall deformities. In addition you have have some degree of symmastia (loss of the space between the breasts). The waterfall deformities can be secondary to failure of descent of the implants or upward migration of the implants because of capsular contracture. If your implants remain soft then it is likely secondary to the former. I would recommend removing your current implants and changing to a subfascial plane. This would address the waterfall deformities and help to correct your symmastia. As always, you should consult with a plastic surgeon certified by the American Board of Plastic Surgery who has extensive experience in revision cosmetic breast surgery. I hope this helps. Good luck.

Thank you for your question. A large portion my practice is dedicated to breast revision surgery. You definitely have a waterfall deformity. These are generally very easy to fix with a lift-mastopexy you should be able to have an excellent result. Best wishes to you.

Thank you for sharing your concerns – I completely understand why this would be frustrating, but the good news is that this can be addressed with revision surgery.
From what you’re describing, it does sound like waterfall deformity (also known as snoopy deformity), where the natural breast tissue sags below the implant. This often happens when there’s more natural breast tissue, and the implant sits high under the muscle while the breast tissue descends over time.
A revision can definitely help. In many cases, the implants themselves can stay in place, but the breast tissue may need to be repositioned or tightened. A periareolar lift (around the nipple) can help reshape the breast and correct the nipple position if it’s pointing outward or sitting lower.
If the implants are truly too high, part of the revision may involve adjusting the implant pocket to ensure better alignment with your natural breast shape. This can create a more balanced, round appearance.
I’d recommend consulting with a surgeon who specializes in breast revision surgeries. These adjustments can make a significant difference in achieving the look you’re hoping for!

Waterfalling is when the breast tissue sags over the implant and is typically placed under the muscle. I'd suggest reattaching your muscles and placing new implants in a subfascial plane. This will place them in a better position in relation to your breast tissue. If you like your size you don't have to replace the implants.

Placing them over the muscle would be a bad idea: increased risk of rippling/visibility of implants, especially over time (despite the declaration that you 'have enough tissue'), increased risk of capsular contracture, and persistent low nipples. What you need now is the same as what you needed two years ago: a breast lift.

The ideal treatment would be to perform a breast lift. But that requires scars and you need to decide if it would be worth it