57, waterfall issue after 11 years, is it time for a revision? (Photos)

Only you can decide when it is time for a revision. From your photos, it appears that you are a great candidate for an implant exchange and revision mastopexy (breast lift). This procedure would bring your nipple back up to a more youthful position by removing the excesss skin that has stretched in the lower part of your breast. We could use your existing scars which have healed nicely. Since it has been 11 years, I would also recommend replacing your implants while we are in there. You can decide whether or not you'd prefer to downsize your implants based on your aesthetic goals. I would likely recommend the use of some type of mesh to create an internal support bra to create more long-lasting results that withstand over time. I highly recommend seeking out a board-certified plastic surgeon that is well experienced in revisional breast surgeries to help you acheive your aesthetic goals.

Hello ,
thank you for your question.
At 11 years post-augmentation and lift, it’s entirely appropriate to consider a revision—especially if you're noticing increased upper pole fullness, changes in breast shape, or asymmetry like the dent in your left breast. The dent may be due to implant malposition, capsular contracture, tissue thinning, or implant edge visibility, and while it can be primarily cosmetic, it’s worth having it assessed to rule out structural issues with the implant or capsule. Revision surgery can address both aesthetics and function, and opting for a slightly smaller implant with an updated lift can reduce long-term sagging, especially as natural tissue aging continues. Given your concerns and time since your original surgery, a consultation with a board-certified plastic surgeon is recommended to assess implant integrity, tissue support, and plan the best approach for revision.

There are many reasons for breast implant revisions most commonly breast lift, implant downsizing, capsular contracture and implant rupture. Breast implants are not lifetime devices and patients need to be screened with US and/or MRI to make sure that the implants are intact.

Hello,There is no exact timing that is recommended for revision of a breast. The FDA recommends implants to be replaced every 10 years, however this is due to the risk of "silent" rupture of silicone implants. Based on your photos, you are correct as having a waterfall deformity. This typically leads to an implant which continues to sit high and provide fullness to the upper part of your breast while your nipple complex drifts downward. The correction for this would be to remove and replace the implants, as you desire to be smaller and perform a breast lift with small reduction. The dent on the lower part of your breast, which is more noticeable on the right is due to scar contraction from the initial surgery. This can be, and will be corrected during the revision surgery. As always, you should speak to a board certified plastic surgeon and make sure you are both understanding of your goals. Hope this helps!

1. Get breast lift with the associated anchor or inverted T scar, plus new implants; given you are so thin I strongly suggest anatomical shaped or teardrop prostheses.
2. Not getting the breast life is still a reasonable option for you, and instead placing the anatomical implants lower at the breast pouch, given it is not actually that much droopy.

With option 1 you get an optimal result with very unsightly scars, with option 2 you get a beautiful but low breast without such scars

Your body, your choide, do not tolerate to be imposed a breast lift as only option.