Will changing to over the muscle implants fix waterfall deformity?

Question

I had a breast lift and implants (325CC under the muscle) in November 2021. I'm going back for a revision as I have bad scarring and still have saggy boobs after a full anchor lift. I've recently come across the term Waterfall deformity and that is definitely my issue. If I change to over the muscle with another lift will that give me better results? It's worth mentioning my before breasts were a grade 3 ptosis so they have improved but not as I would of hoped.

Gary M. Horndeski, MD · Answer

No, changing to over the muscle will not fix waterfall deformity. Water deformity develops because the implants are at one level and the breast tissue is at another. The technique I recommend is explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Richard Baxter, MD · Answer

There is no benefit IMO to placing implants in front of the muscle to help correct waterfall deformity unless the implants are too high. Touch-ups are very common with the combination of implants and breast lift. Most likely all you need is to have the lift adjusted but hard to say without pictures and an in-person exam.

Ronald J. Edelson, MD · Answer

It sounds like the lift needs to be redone. It’s possible that your nipples were not raised adequately but I can’t be sure without photos

Daniel Barrett, MD · Answer

Dear btaaffe,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

Typically, keeping the implants behind the muscle gives good support to your implants. Your own tissue is sagging and may need an internal mesh bra for better support. Moving the implants in front will remove the waterfall effect, but you may sag more.

Douglas Taranow, DO, FACOS · Answer

Including photos would have aided in accurate assessments of your issues.  usually, a revision mastopexy alone would fix a waterfall deformity.  Certainly placing the implants a little lower and subglandular also reduce the possibility of the waterfall deformity as well.
Best wishes.
Dr. Taranow

Richard P. Rand, MD, FACS (retired) · Answer

There are very few reasosn why you would go above from under. Often, the under muscle implants need nothing and you need to redo the entire lift perhaps with a different surgeon. Sometimes you need to revise the implants but not by going above. Your surgeon should mention and discuss the risk that above the muscle position carries with damage to the breast blood supply which can lead to nipple necrosis in a breast lift.

Will changing to over the muscle implants fix waterfall deformity?

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