A waterfall deformity occurs when the natural breast tissue slides down over and below a breast implant that stays high on the chest wall. The implant creates a firm upper shelf, while the breast and nipple hang beneath it, like water running over a ledge. It is usually corrected with a breast lift, often combined with an implant change or a change of pocket.
What a waterfall breast looks like
- Upper fullness: a rounded, firm upper breast where the implant sits.
- Descended tissue: the soft breast tissue sits below the implant and may hang over the fold.
- Low nipple: the nipple points downwards and sits below the centre of the implant.
- A visible step: a line or ledge between the implant and the breast tissue beneath.
Because of its profile, the appearance is sometimes called a ‘Snoopy’ breast. It can affect one or both sides.
Why it happens
The implant and the breast tissue behave differently over time. An implant placed beneath the chest muscle is held in position by the muscle and its capsule, while the breast tissue in front of it continues to respond to gravity, hormones and weight change. Common contributing factors include:
- Pre-existing sagging: an implant alone was used in a breast that already needed lifting.
- Pregnancy and breastfeeding: breast volume increases then decreases, stretching the skin.
- Weight loss: loss of breast volume leaves loose skin over the implant.
- Ageing: skin loses elasticity and the ligaments supporting the breast stretch.
- Capsular contracture: a tightening capsule can hold the implant high while the breast drops.
How it differs from bottoming out
In bottoming out the implant has moved too low, below the fold, so the nipple looks too high. In a waterfall deformity the opposite relationship occurs: the implant is relatively high and the breast tissue and nipple have dropped below it. Both can produce a double contour, which is why an accurate diagnosis is the first step in planning revision. The related double bubble guide explains the overlap between the terms.
Assessment
At consultation, Mr Nassab will measure the position of the nipple relative to the fold and the implant, check the firmness of the capsule, assess skin quality and discuss your goals. Photographs of how your breasts looked before and after the original operation can help. Previous operation notes, if available, show the type, size and plane of the implant. Occasionally a scan is recommended to check implant integrity.
Treatment options
Correcting a waterfall deformity usually aims to bring the breast tissue and implant back into one smooth shape:
- Uplift with implant exchange: a mastopexy raises the nipple and tightens the skin so the breast sits over the implant. The implant may be changed at the same time.
- Changing the pocket: moving the implant from beneath the muscle to a position in front of it, or releasing a tight capsule, can let the implant and breast move together.
- Smaller implants: a smaller implant with a lift can give a softer, more natural shape and less weight on the tissues.
- Implant removal with uplift: some women choose to remove implants altogether and reshape their own tissue.
A bigger implant on its own rarely corrects a waterfall deformity and can increase stretching over time.
Scars, recovery and realistic goals
An uplift adds scars around the areola and, in many cases, vertically down to the fold and sometimes along the fold. These usually fade over 12 to 18 months but remain visible close up. Most people return to desk work after about two weeks and full exercise at about six weeks, wearing a supportive bra throughout. Revision aims for a better blended shape, although some asymmetry is normal and further change can happen with future weight change or pregnancy.
Cost and timing
A change of implants with an uplift costs from £13,500; implant removal with an uplift costs from £11,500. The £150 consultation is charged separately. If you are planning a pregnancy or are still losing weight, it is usually better to delay revision until your breasts and weight have stabilised, as further changes could affect the result. Cosmetic surgery is for adults aged 18 and over.
Frequently Asked Questions
Can a waterfall deformity be fixed without a lift?
Occasionally, if the change is mild, adjusting the implant pocket may help, but most cases need an uplift to reposition the breast tissue.
Why did my breasts drop but my implants stayed high?
Implants beneath the muscle are held in place, while breast tissue continues to respond to gravity, pregnancy and weight change.
Is it better to wait until after having children?
If you are planning further pregnancies, it is often sensible to wait, as breast changes may affect the result of revision.
Will there be more scars?
An uplift adds scars around the areola and often vertically below it. These typically fade over 12 to 18 months.
