375cc & 400cc implants from 9 years ago sagging, is this the waterfall effect? (Photo)

Hi, thanks for your question. Based on your photos, you have very typical appearances a few years down the line following subpectoral breast augmentation. You do have a degree of waterfall effect - the soft tissues / gland are falling off the implant which is being held in its original position by a combination of the muscle and implant capsule. You have a number of options including simple implant removal, implant with uplift, or implant exchange and uplift. These procedures could also be combined with fat grafting if you wished to boost your volume without the use of implants. The best solution for you will depend on your goals.

Dear MissAnonymous1,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

A waterfall effect is when the implants stay high and the breast tissue falls off the implant. At this time, I recommend 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.

From the submitted photo it appears the issue is the breasts are sagging. This is not the waterfall effect which is where the breast tissue sags over top of the implants that are held higher. Exchanging for smaller implants and having a breast lift should give you an improved shape.

Just based on your one photo, your breast tissue is probably sagging and not your implants. You could go smaller, have the lateral pockets tightened and do a lift for good results.

The goal of having revision surgery should be to change your outcome so hopefully it would not leave you looking the same.
It does look like you have mild/moderate breast ptosis. I’m appreciate to mention sides because your picture is reversed due to using a mirror.
I suggest following up with your plastic surgeon of schedule a few in person consults with other plastic surgeons in your area.
Best,
Mats Hagström MD