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

Hello,
Thank you for the question. It appears that the breast tissue has loosened over the implant (waterfall deformity). This requires a lift (or re-lift) to elevate the nipples and tighten the skin around the implant. At the same time, the implant will be exchanged to a new one. I wish you the best.
Vasileios Vasilakis, MD, FACSDouble Board Certified Plastic SurgeonHouston, TX.

It all depends on the integrity of the implants and how much you are concerned with the shape of your breasts . First and foremost I recommend having a consultation with a board certified plastic surgeon in your area . They will be able to organise an ultrasound scan to check the integrity of your implants . If they are ruptured it becomes necessary to do something about them sooner rather than later. If they are not ruptured and you do not have any discomfort you could keep them and have them checked on a yearly basis If you do not like their shape there are 2 options- exchange of implants and another breast uplift; you will be able discuss the type and size of your new implants with your surgeon- removal of implants and auto-augmentation with your own breast tissue +/- fat transfer
Hope this helps!

This is an excellent question, and one that comes up often for women around the 10–15 year mark after augmentation and lift. Increased upper-pole fullness and a small dent or contour irregularity on one side, can happen gradually over time as the breast tissue and implants both age.
Fullness at the top may indicate capsular tightening (capsular contracture) or a shift in implant position, especially if your implants have been in place for over a decade. The “dent” you notice on the lower side of the left breast could be related to tissue thinning, scar tissue changes, or mild implant malposition. These are often cosmetic issues at first but can progress if not evaluated.
At 57, it’s very reasonable, and wise, to have your implants and breast tissue checked. A consultation with a board-certified plastic surgeon (ideally with an ultrasound or MRI if implants are older) can help determine whether the changes are purely aesthetic or if there’s any structural concern.
If you’re thinking about going slightly smaller, that’s a wonderful idea for longevity. A smaller, lighter implant combined with a subtle lift can restore a youthful, natural shape and help reduce downward pull over time, especially as skin elasticity changes.
You don’t need to rush, but it’s absolutely the right time to have it looked at. A professional assessment will give you peace of mind and a plan for maintaining both the health and beauty of your results moving forward.
Dr. Sibel Atalay, MDBoard-Certified Plastic Surgeon & Destination Doctor

The recommendation is that you exchange your implants every 10-15 years. At 11 years you fall within the range. Failure to exchange your implants at that time is not a threat to your health but risks implant rupture which can cause deflation with saline implants and capsular contracture with silicone implants. the added fullness in your upper poles likely represents a capsular contracture and is treated with capsulectomies (capsule removal). With capsulectomies and replacement of a similar size implant, your implants may sit lower and be acceptable in appearance. However the most reliable outcome, especially if you want to go a little smaller will come from removal/capsulectomy/replacement and mastopexies (breasts lifts). It looks like you already have mastopexy scars so this would simply be re-lifting leaving you with an identical scar burden. See a board certified plastic surgeon to develop and individualized plan.

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.

After 11 years, it’s completely normal to start noticing changes in your breast implants and the surrounding tissue especially following a breast augmentation with lift. From what you describe increased upper pole fullness and a progressive dent in the lower portion of the left breast it’s very likely that you are a candidate for a breast revision surgery.
While some of these changes may seem cosmetic, they can also indicate underlying structural issues such as implant malposition, capsular contracture, or natural tissue thinning due to age and gravity. At age 57, it’s important to assess both the aesthetic and functional condition of your implants and breast tissue to avoid further complications down the line.
If you’re noticing visible distortion, asymmetry, or if your implants no longer feel or look as natural as they once did, that’s usually a clear sign it’s time to consider a revision. Many women in similar situations opt for smaller implants or implant removal with a lift (explant with mastopexy) to achieve a more age-appropriate, natural look and reduce long-term weight-related effects on the breast.