Do I Have Waterfall Deformity Post BA? (photo)

Question

I am only 1 day post surgery but i'm very worried i have 'waterfall deformity' my implants sits very high and my natual breast tissue appears to be dropping over it. Im aware i need to allow time for the implant to settle and drop but im very worried as my pictures do not look like other pictures ive seen post op. i was previously a 12 B (full) with minor droop & implants were placed behind the muscles Allergan 325 CC round/textured/ high profile. Do i appear to have 'waterfall deformity'?

Richard H. Tholen, MD, FACS · Answer

Yes, your own breast tissue appears to be drooping over submuscular implants that are too high, giving you a "Snoopy-dog" deformity. "Waterfall" is another colorful term that denotes the same appearance.

	Of course, 1 day post-op is early, and most anyone will ask you to wait patiently for things to soften, settle, and drop into position. And this does indeed always occur to some extent in each patient.

	There's only one problem with this situation--you have textured implants. If the textured surface "works" properly and "adheres" to tissues similar to Velcro, there will be little to no dropping possible,even with additional passage of time, and even if an elastic band is used. How can an adherent (because of the texture) implant "drop" into a new position over time?

	There is no reason to utilize textured implants below the muscle, IMHO. Textured implants were designed to reduce capsular contracture in the above-muscle submammary implant position, and were thought to work by "breaking up" the linear contractile vector forces of capsular myofibroblast/collagen in the capsule, as well as possibly "isolating" ductal bacteria from freely moving around a non-textured smooth implant/capsule interface. Some studies showed reduced capsular contracture for routine above-muscle textured implant placement; others did not.

	When the FDA restricted use of silicone gel implants in 1991, saline implants became the norm, and the usual above-muscle placement had the same capsular contracture issues as with silicone implants in this plane, so the choices were smooth or textured saline implants instead of silicone, and initially surgeons continued to use the same above-muscle position.

	But (regardless of smooth or textured), with saline implants above the muscle, visible rippling became a greater issue. So we went below the muscle. This reduced the rippling concern, but it also turned out to significantly reduce capsular contracture, likely because of fewer bacteria in the submuscular plane (but NOT if the surgeon used blunt--bloody--dissection to create the submuscular pocket as many did above the muscle). This led to surgeons and patients alike claiming that "Below the muscle is much more painful!" True, but only if the surgeon does not use careful, precise technique with meticulous hemostasis. But I digress.

	Unfortunately, when some surgeons went below the muscle for the reasons above, they continued to use the implants they had become "used to," and simply used textured implants below the muscle. Not only is this basically unnecessary (since it turned out to be the less-bacteria submuscular position, NOT the texture, that reduced capsular contracture), textured adherence prevents implant movement, limits dropping into position, and (with saline) increases the risk of implant deflation. With silicone gel implants deflation is not an issue, but failure to move and drop remains an issue with textured implants.

	One other consideration is that high profile implants have a narrow(er) base and more projection, giving the very high, round look you have and presumably do not like.

	From my perspective, you would likely have dropped into position over time with smooth implants, and moderate or moderate plus profiles would look more natural and less "high, tight, and Baywatch coconut" in appearance. But with textured and HP, this may not change enough even over time to achieve a look that is satisfactory. I truly hope I'm wrong for your sake; otherwise, revision is going to be necessary. See how things go and give yourself 6 months. If revision is necessary you can adjust size, position, and go with smooth lower profile implants in the same submuscular plane. Good luck and best wishes! Dr. Tholen

Michael Loffredo, MD · Answer

although the implants appear high on the chest wall with the breast issue falling off the implant, this can change dramatically over the next six to eight weeks.  I recommend close follow up with your plastic surgeon, aggressive implant displacement exercises and upper pole banding/bandeau

James E. Murphy, MD, FACS · Answer

You are one day post surgery and need to give your new breast implants time to drop into the breast pocket.  Most Breast Augmentation patients who are one day post surgery look a bit distorted.  Remember, your breast tissue is stretching to accommodate your new implants.  You need to concentrate on healing. When you see your surgeon, I'm sure he/she will be showing you exercises to help move the implants down.

Garrett A. Wirth, MD, MS, FACS · Answer

At one day after surgery, it is far too early to determine your final outcome or shape. At this point, I recommend that you give the implant time to settle in to their final position over the next several weeks/months. In particular, smooth, round implants tend to ride up higher in the early postoperative period in my opinion but also settle into a position well overtime. Wishing you all the best.

Do I Have Waterfall Deformity Post BA? (photo)

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Do I Have Waterfall Deformity Post BA? (photo)

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