There are so many factors that will effect the ultimate outcome and appearance of your breasts following implant removal. These include:
1.Age (yes, over 40 does mean less elasticity/contractility than a 25 year old but usually more than a 60 year old)
2.Size of implant
3.Number of years implant is in place
4.Over or under the muscle placement
5.Length and duration of nursing while implants are in place
6.Natural volume of breast tissue
In summary, it is my experience that If you go with a conservative volume implant (that is a subjective and not objective term) relative to your breast tissue, it is likely that you will have some loss of upper fullness with implatnt removal but not a drastic amount of sag (ptosis).
I have prepared a video on youtube entitled Breast Augmentation Overview in which I show the consequences of two patients who have undergone implants removal:
1.Scroll to 1 min into the video and you will see a 40 year old who underwent implant removal 1 year after placement. I do not have the pre implant photos because the augmentation was performed elsewhere and the patient preferred to have me remove the implant rather than the initial surgeon
2.Scroll to 1 min 30 sec into the video and the second patient is a 42 year old who had implants in place for 20 years.
Occasionally, it is obvious that a person will need a lift and implant removal and replacement can be performed simultaneously although there are some concerns about the circulation to the nipple areolar complex. I generally prefer a two stage approach with implant removal followed b 6-9 months of observation and then decide on a lift at that point in time. If there is a question about the need for a lift, saline implants can be deflated with a needle to get a rough idea bout the degree of sagging or droop (ptosis) followed by observation for 1-2 weeks to observe the effects of immediate contraction