Deformity With Breast Implants
April 22, 2025 | 4 minute read
By Dr. Alexander Gougoutas
If you’ve had breast implants for many years and have noticed a change in the shape of your breasts, you’re not alone. While there are many reasons breasts with underlying implants may change shape over time, you may be experiencing something we call the waterfall deformity. This is a fairly common condition that I see in many patients who have implants for many years, and while it might be frustrating or even unsightly, there is good news is: it’s totally manageable and you have options.
What is a Waterfall Deformity?
The term waterfall deformity refers to a situation where the breast tissue has aged and drooped – or “fallen off” the implant. It often comes as a surprise to patients that the issue is not necessarily one with the implants themselves, which are often in an appropriate position, but rather results from the natural aging process of the breast. Over time, the breast tissue naturally loses elasticity and volume. The result? Your breast tissue slides downward over the implant, creating a shape that many describe as unnatural or “bottom-heavy” where the implant seems too high and the breast tissue seems too low (i.e the breasts and the implants are not communicating with each other).
What Can Be Done About It?
Management really comes down to your goals and what you want your breasts to look and feel like moving forward. There’s no one-size-fits-all-answer, but I generally recommend a two-step approach that gives both immediate improvement and long-term flexibility.
Step 1: Remove the Implant and Perform a Mastopexy (Breast Lift)
In this first step, I remove the implant and lift the natural breast tissue to a higher, more youthful position. I often do this using absorbable mesh, which restores the infrastructure and shape of the breast. This mesh supports the tissue as it heals, giving a better long-term result. If the mesh is absorbable you may ask, why use it? The answer is the thin layer of scar tissue the mesh leaves behind when it goes away which essentially acts like an “internal bra” to support the breast tissue, and in essence restore the strength of the ligaments supporting the breast shape.
At the same time, I often recommend fat grafting – taking your own fat from another area of the body using liposuction and injecting it into the upper portion of the breast. This helps restore volume to the hollowed or flattened upper pole of the breast, giving it a more natural look.
This step alone can be transformative for many patients. It gives a rejuvenated breast shape and contour without the need for new implants – at least not right away.
It is important to understand that fat grafting cannot restore all the volume of the implant. It does, however, provide some natural fullness to the upper portion of the breast which many patients, who no longer desire implants, view as a very pleasing and natural alternative.
Step 2: Take a Breather
After this initial surgery, we can take a break before deciding whether to place new implants. This gives your body time to heal, allows the breast tissue to settle and gives you time to evaluate the restored position of your native breasts without implants.
Some patients are thrilled with the results after the lift and fat grafting and choose to stop there. Others – about 50% of women- decide they would like more volume or fullness and opt for re-augmentation with new implants.
The good news? The re-augmentation is a breeze. Because the breasts are already lifted and supported, and the nipple position has been restored to a pleasing position, re-augmentation is far more predictable and quick.
In Summary
The waterfall deformity is a natural aging change that happens when breast tissue begins to sag over a long-standing implant. It may look like the implant has moved (and in some cases it has), but it’s usually your own tissue that has changed. Fortunately, there are options to correct this.
Whether you’re looking to restore your natural shape, add volume, or simply understand your options, the first step is always a conversation. If you’re experiencing changes in your breast shape and wondering what’s next, let’s talk about what approach would work best for you.