425cc, round silicone, 5'3, 6 months post-op - what has gone wrong here? (Photos)

You probably had a narrow breast with no "underboob" to begin with. The lower part of your breast envelope is tight and this forces the implant higher. You will probably need to score the capsule (capsulotomy) of the lower part to allow the implant to "stretch" the lower part of the breast AND you ought to convert to a lollipop mastopexy (in other words, accept a vertical scar on the breast). I don't think you necessarily have to get a new implant.

Hi This is Dr Özge Ergün
First of all, thank you for sharing your story and photos.
You had with pre-existing Grade I or II breast ptosis prior to the procedure. The decision was made to proceed with a subpectoral (submuscular) implant placement via an inframammary fold (IMF) incision.
"This surgical approach led to a predictable complication: the muscle's static, superior support holds the implant in an elevated position, while the ptotic glandular tissue (parenchyma) is free to descend over the implant capsule. This creates a visually apparent double-contour deformity, often termed the 'waterfall' or 'Snoopy's Nose' ptosis."
"A subfascial or subglandular plane would have been a more anatomically appropriate choice in the absence of a concurrent mastopexy, as these planes allow the implant and the breast envelope to settle congruently."
"Furthermore, the surgeon's expectation that the Inframammary Fold (IMF) would migrate caudally (downward) post-operatively did not materialize, as the superiormost pole of the implant remained fixed and elevated by the pectoralis muscle. Consequently, the lower placement of the incision has resulted in an incongruous IMF position relative to the supported implant, complicating the aesthetic result."
Would you like to explore the common revision strategies—such as a mastopexy with pocket adjustments—that are typically used to correct this type of post-surgical deformity?

Hello,
Thank you for providing detailed photos and background. At just over 6 months post-op with 425cc round silicone implants placed submuscularly and an areolar lift, it appears that you may be experiencing a combination of implant malposition, poor lower pole expansion, and possibly an element of "double bubble" or "waterfall deformity", particularly if your natural breast tissue is sagging off the implant when lying on your side. This can occur when the implant remains high on the chest wall due to muscle tension or scar tissue, while the natural breast tissue descends below, creating a step-off or distorted contour. The asymmetry and lack of lower pole fullness suggest that pocket revision, possible implant lowering, or internal support (e.g., with mesh or capsulorrhaphy) might be required to improve shape and symmetry. Scar concerns and areolar distortion from prior suture issues may also be addressed during revision. A thorough in-person evaluation, including implant positioning and soft tissue behavior in different positions, would be key in guiding your revision plan

If there was a preop pic part of the photos - that would further help understand your surgical journey. But from the photos you have uploaded - likely you need to revisit with your surgeon about possibly lowering the pocket to see if the implant can set into a better position (to give you more lower pole). It unsure if the periareolar lift lowered your NAC as well, therefore likely need to revise that part or convert to a lollipop incision. In the meantime - do breast massages to try to force the implant lower (you can search on Youtube for breast massage post implant videos). Seek a second opinion as well to see if there's a different approach. Hope this helps.

To summarize in a few bulletpoints:
-you did not get a lift, only a periareolar skin resection, this is not a breast lift no matter how much you are told or read it is
-however, I don't believe your ptosis (droopiness) grade makes the breast life benefitial, too much scarring for such little gain, I'd have gone for breast implants only, but properly placed
-your implants are located too high, you need revision, they won't go into place by themselves
-you likely have animation deformity, an awkward change in shape when contracting the pectoralis

I suggest you seek advice of a surgeon experienced in revision mammoplasties, so that the whole plan is re-done.

Seeing you before pictures may help but you clearly need a revision. The hard part is the Areola is too big now, your implants too high and you may have some capsular contraction which needs an exam to confirm. IMHO a peri areola lift (Donut lift) is the most common lift that creates hard to fix problems. Pease see a few experienced plastic surgeons for consultation. You may need to remove implants then wait and redo the lift then 4-6 months later put implants back in. Goog luck!

Hi, sorry your experiencing this after your breast surgery.

It is fixable! Your surgeon would be able to figure out the different components that are giving this result. Have your implants moved upwards since the surgery? This could be a sign of a capsular contracture which is lifting the implant out of your natural breast tissue giving the appearance of the natural breast tissue falling off the face of the implant. If you and your surgeon find that the implant is in a suitable position then you would need a breast lift to center the nipple and areola over the breast implant. An additional removal of breast tissue on the bottom of the breast can be performed to reduce your chances of having it recur in the future. It will also give you the opportunity to revise your scars. You will need no less than a "lollipop scar" pattern as a periareola lift would not be adequate in any way!

Best of luck,
Dr. Reilly

Thanks for reaching out and sharing your concerns. While we didn’t perform your original surgery, we can see why you’re feeling unsure about your results.

From what you've described and the image provided, it sounds like you may be experiencing a combination of implant malposition, possible waterfall deformity (where natural breast tissue drops below the implant), and some scar placement or healing issues.

I'd recommend an in-person evaluation by your surgeon or a board-certified plastic surgeon is essential for a proper diagnosis and treatment plan.

It’s understandable you’re concerned about the shape irregularities and scar placement you’re experiencing after your surgery. At around 6 months post-op, implants have usually settled significantly, but some issues can still persist or become noticeable.
What you’re describing sounds like a “waterfall deformity” or a mismatch between the original breast tissue and implant positioning. This happens when your natural breast tissue slides down off the implant, creating an uneven contour, especially noticeable when lying on your side.
Possible reasons include: • High Implant Placement: If implants are positioned too high, natural breast tissue might hang lower. • Insufficient Lift: Sometimes, more aggressive lifting or tissue tightening is necessary. • Scar Positioning: Scars placed incorrectly can contribute to asymmetry or unusual shapes.
Revision options to address this might involve repositioning implants, adjusting scars, or performing an additional lift or tightening procedure.
Given the complexity of your concerns, a detailed evaluation from an experienced surgeon would be beneficial. They can clarify exactly what’s happening anatomically and recommend personalized solutions.
I hope this provides clarity about your next steps. Consulting with your surgeon or seeking a second opinion would be helpful.
— Güray Yeşiladalı, MD

Great question. ​Without examining you it is difficult to be certain but based on the photos it looks like a few issues going on here. There is a significant implant issue which would be better diagnosed in person, however it appears as though your surgeon chose implants that were too wide for your frame and under dissected the pocket, which is why they are shaped more like vertical ovals rather than circles. They also seek to be too high, which is either a superior malposition or your surgeon put them completely under the muscle rather than doing a proper dual plane augmentation. The reason you see your breast tissue hanging off the implant laterally (a.k.a waterfall deformity) is because you needed a stronger lift technique. A periareolar lift was never going to elevate the areolae enough nor reshape the breast enough. A vertical lift or anchor lift were really what was needed. Sorry for the situation you’re in but if you see an expert in breast implant revision in your area these are all things that can be fixed.