The implant stays high and firm; the natural breast ages, softens and descends over it — and a bigger implant is precisely the wrong fix. The honest mechanics and the lift conversation.
An augmented breast is a partnership: your living tissue in front, a device behind. The device doesn't age, breastfeed, or crash-diet; your tissue does all three. When the envelope loosens — pregnancy, weight swings, simple years — gland and skin obey gravity while a well-scarred (especially submuscular) implant holds its pocket. The result is the waterfall: a firm upper mound with natural tissue cascading over its lower edge — two contours where there should be one, most visible in profile and lean-forward.
Nothing failed. The surgery that looked perfect at year one did its job; biology then did its own. Post-pregnancy involution is the classic trigger (that article maps the wider changes), major weight loss the second (the GLP-1 era is minting new cases), and time alone suffices in lax-tissue anatomies. Submuscular placement — chosen for excellent reasons — slightly raises the odds simply because the muscle anchors the implant so well while tissue in front keeps moving.
The intuitive request — "just give me a bigger implant to fill the droop" — is the deformity's best friend: extra volume adds weight to an envelope that's sagging because it can't carry its current load, papering over the double contour for a season while stretching the tissue faster. Clinics happy to sell that upgrade are selling you the same appointment again in three years, one size worse. The size-regrets ledger already knows this story.
Realign the partnership: lift the descended tissue back over the mound. That's augmentation-mastopexy territory — a lift tailored around the existing (or exchanged) implant, sometimes with plane adjustment so mound and tissue travel as one, occasionally with a size reduction that flatters more than the old volume did. Whether it's staged or single-session is anatomy-dependent (the staging article argues both honestly). Early waterfall with mild descent sometimes waits under observation — descent is slow, and surgery timed once beats surgery timed twice. Profile photos via the free assessment place you on that map before any decision spends money.