How to Fix Breast Augmentation "Waterfall" Effect?

Had first surgery in July 2009. Revision last month. Doc says I have terrible skin quality and repositioned implants. Great placement and wonderful pole position. But even after 2 weeks, breast tissue feel off pec muscle, thus creating a "waterfall" effect. Doc says some South American docs are working with mesh to hold tissue on pec muscle but he didn't recommend for me. Any suggestions? You can see by the photo the implant remained high, tissue just fell off.

Doctor Answers 9

Breast Augmentation/Mastopexy and Revision?

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Thank you for the question and picture.


Although the results of  breast surgery in your case will never be “perfect”,  I think there is certainly room for improvement. This may involve adjustment of the breast implant pocket and further tailoring of the overlying “skin envelope”.

Please do your due diligence and find a well experienced plastic surgeon with significant demonstrable examples of his/her work.

Best wishes.

Waterfall effect: breast tissue falls off of breast implant

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Your breast and implant procedure are treating two different conditions and it would be best for you to wait approximately 6-9 months and then consider a revision. At this point in time, it is quite likely that, using your existing incsions albeit with lengthening the lateral limb of the horizontal component, you will be able to reduce the redundant tissues of the lateral pole of your breast mound.  

Breast augmentation revision, breast lift

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Given that your photo is low and only shows one breast without any before I would refrain from commenting.  There are multiple factors that play a role in your post-operative result.  How about posting a picture from the neckline down to below the breasts.

You have separtion of the breast tissue from the implant

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The picture that you have attached shows that implant is in a high position and the breast tissue is sliding off of the impolant. The implant looks like is under the muscle and not filling the lower part of the breast.

This is a common problem with breast augmentation /mastopexy combination. You need to wait few months before even thinking about the revision. You have swelling. The scar revision and making the skin thighter is not the answer and you will need to have the pocket revised if you are not happy with the final result.

Revision breast lift can be simple.

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Your breast implants look fine. I think the shape of your breasts can be improved by revising the breast lift, using the scars you already have.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Recurrent breast drooping

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I have seen this on a couple of occasions, and have re-tightened the lateral flap of skin and breast tissue both vertically and horizontally with good results. It also appears as though your implant may be a little too high. If this is that case, then lowering it will help reduce your superior pole fullness (the fullness of your upper breast) and will help improve the fullness of the lower portion of your breast.

You simply have too much skin

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A tightening of your mastopexy especially laterally (on the side) should help. I do not know why you have "dropped" so quickly, but your pictures demonstrate too much skin that potentially could be tightened. In my opinion, mesh would not help at all.

David Shuter, MD
Jupiter Plastic Surgeon

A revision of breast lift is needed to correct 'waterfall' deformity

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You appear to have sagging of your breast tissues relative to the breast implant. Your nipple/areola appears to be in good position. I would recommend a revision of your mastopexy using your existing vertical and transverse scars. This will tighten the lower pole of your breast and restore a natural lateral curvature to your breast. I have no experience with mastopexy techniques using mesh (Goes?) but some of the more experienced surgeons on this forum may have.

Recurrent breast laxity

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Not having operated on you myself, after years of experience I can say that there are a few patients whose skin is so bad that recurrent laxity is almost unavoidable.  The young surgeon will think you can just tighten it again, but time will teach them differently.  

Remember that the fact of needing the lift means that your elasticity is not too good and some patients are worse than others. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.