3 years post revision surgery - Is this waterfall deformity and how involved is it to fix? (Photos)

Question

I believe I have a waterfall deformity in my left breast. I am a 52 year old woman. I had breast revision surgery 3 years ago switching from 375 cc submuscular saline implants to 400 cc submuscular silicone implants. The left implant has always been higher, looking more pushed up than the right. I feel like it just needs to be lowered and that would correct it. I am wanting to know if this is the case or is it more involved than I am believing.

Robert M. Lowen, MD · Answer

Dear Laurlove,
  That is a very astute question, and you may be right.  This resembles what happens in a primary breast augmentation when the muscle has not been completely released and the implant goes in too high and stays that way.  The treatment is to release the muscle below the implant.  This is interesting because you already had implants and presumably they looked symmetrical without the left being too high before you had them replaced.  This would not then be strictly considered a waterfall deformity because a waterfall deformity is when the position of the implant is OK, but the laxity of the breast allows the breast tissue and skin envelope to descend down over the implant.  That usually requires a breast lift.
  In this case, it looks more like the implant is too high and you say it has been from the time it was placed.  Often, when re-augmenting to a larger size, a capsulotomy or opening of the capsule (pocket) has to be done to accommodate a larger size.  If this was needed and insufficiently done on the left, the left implant will ride high from the beginning as it did in your case.
   Treatment may be as simple as doing an adequate capsulotomy .  After doing that, one could always evaluate to see if breast/skin laxity is present requiring a breast lift.

Daniel Barrett, MD · Answer

Dear laurlove,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Harry T. Haramis, MD, FACS · Answer

All breasts are different left to right before and after any surgery. They can also heal differently.

The higher side likely has some capsule or scar tissue which can distort that side.

Removing the scar tissue usually benefits from changing the implant and adding mesh to decrease recurrence along with lowering the implant pocket for better symmetry.

This will alleviate the water fall deformation.

This would be confirmed and discussed during consultation with a plastic surgeon.

Ned Snyder, IV, MD · Answer

Thank you for submitting your questions/photos.  I’m sorry you are experiencing some breast asymmetry after your augmentation.  Based on your photos, you have several options.  You can revise the left breast by opening the capsule around the implant and letting that implant sit lower in the breast pocket.  There’s a chance this could return with time.  Another options would be to move your implants from beneath the muscle to on top of the muscle and support them using a small piece of dissolvable mesh.  This would reduce the risk of the implant creeping back up on the chest wall.  I highly recommend you seek out a consultation with a board certified plastic surgeon to review all of your options.  Good luck and thanks again for reaching out!

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  You definitely have a waterfall deformity.  I have been in practice for over 30 years, and revisionary breast surgery is a large portion of my practice.  In your case, I would suture the pockets-internal bra to bring the implants closer together and perform a mastopexy-lift.  You should be able to have a beautiful result.  Best wishes to you.

Gary M. Horndeski, MD · Answer

Your breasts have fallen inferiorly and laterally. At this time, I recommend explantation and breast lift using the Bellesoma. 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.

Best Wishes,

Gary Horndeski, M.D.

3 years post revision surgery - Is this waterfall deformity and how involved is it to fix? (Photos)

Answers (6)

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