Resumen

Objectives: To develop an anatomical-functional classification of waterfall deformity and a clinically oriented surgical algorithm for each subtype. Introduction: Waterfall deformity is a frequent yet poorly classified complication following breast augmentation, characterized by glandular tissue descent over a stable implant. Despite its prevalence, there is no standardized definition, classification, or treatment protocol in the international literature. The condition is often confused with other deformities such as snoopy breast, double bubble, or implant malposition, complicating accurate diagnosis and surgical planning. Materials / method: A prospective analysis was conducted on 197 patients presenting with waterfall deformity following breast augmentation between 2017 and 2024. Clinical parameters included implant type, surgical plane (submuscular, subglandular, dual-plane), previous mastopexy, native breast anatomy, and ptosis severity. Based on clinical patterns, a four-type classification was proposed. Individualized surgical strategies were defined for each type, involving mastopexy, pocket remodeling, capsulectomy, and implant exchange. Results: Four clinically significant types of waterfall deformity were identified: • Type I – Glandular ptosis with dual-plane placement (14.7%) • Type II – Snoopy breast deformity with cranial implant malposition (72.1%) • Type III – Glandular ptosis with subglandular implant position (5.1%) • Type IV – Capsular contracture combined with glandular ptosis (8.1%) Each type was matched with a specific surgical correction algorithm. Patient satisfaction exceeded 90% at 12-month follow-up. Pocket remodeling with inferior muscular-capsular flap repositioning in Type II yielded stable and predictable outcome Conclusion: 1. The most complete definition of postagumentation deformation “waterfall” has been formulated and a 4-type systematization has been proposed. 2. The algorithm-based surgical approach demonstrates high efficacy and reproducibility. 3. The methodology is suitable for both clinical use and surgical education. 4. A differential and type-specific strategy significantly improves aesthetic results and reduces revision rates.