Objective. To identify clinical types of waterfall breast deformity and surgical correction algorithm taking into account their morphological characteristics.

Material and methods. There were 197 patients with waterfall breast deformity following breast augmentation (2017-2024). We assessed implant placement, ptosis, capsular contracture, and anatomy.

Results. Four types of deformity were identified: glandular ptosis in dual-plane placement; high-positioned implant with glandular ptosis (Snoopy breast); ptosis in subglandular placement; combination of contracture and ptosis. Individual surgical algorithm was proposed for each type: mastopexy, recess remodeling, capsulectomy, and implant replacement.

Conclusion. The proposed systematization allows for accurate diagnosis and planning of waterfall breast deformity correction reducing the recurrence rate. The algorithm demonstrated high reproducibility and clinical effectiveness. These facts make it useful for surgeons and in educational purposes.

Keywords. mammoplasty, complications, waterfall deformity, implant, mastopexy