60 Years Old, Wanting to Replace 23 Year Old Breast Implants, Options? (photo)

Thanks for your question and  the attached photo. As you note, he had marked capsular contractures and marked ptosis, or sagging.

If indeed you are not concerned about the ptosis, then addressing only the implant seems completely reasonable. he would be best served by replacing these with somewhat smaller implants and moving them below the muscle.

After that surgery he may  no longer agree with your preoperative assessment about the sagging in which case he could do a breast lift. many surgeons would favor doing the procedure in two separate stages anyway  .Best wishes.

I do not think it is a good idea to just exchange the implants. You need a lift with the implant exchange.  They certainly can be made smaller.

I am in agreement with your surgeon that, without a lift, the result will not be aesthetically pleasing and will look worse than if you removed the implants and went down to a B cup. The capsular contracture is severe and you will be at risk for capsules from any reoperation, although the risk is lower if the implants are under the muscle. As breast augmentation patients age and reach Medicare age, it is time to re-evaluate how to deal with implants, particularly if complications such as contracture develop.

VAW: Thanks for the photo & question.  I assume that your silicone gel implants were placed on top of the pectoralis muscles because this plane was associated with a higher rate of capsular contracture, which you have experienced.  Do consult with a PS and discuss implant exchange (subglandular to subpectoral) for several reasons: a) improved superior pole coverage; b) more natural appearance; c) greater resistance to capsular contracture.  However if you agree to the subpectoral plane, you should inclue a mastopexy (breast lift) because the breast skin has been stretched out and the nipples are on different levels.  Even if you are not concerned about saggy breasts, removing the old implants and the surrounding scar capsule as well as reinserting silicone gel implants above the muscle will not significantly change your appearance, as there is a relative excess of breast skin to contain your implant.  Good luck

Thank you for the question and pictures.

You will find that you have many options to consider.

1.Removal of implants/capsulectomy.

2.Removal of implants/ capsulectomy and breast lifting.

3.Removal of implants/capsulectomy/ breast lifting and breast  reaugmentation.

What you choose to do will depend on your goals.  The more surgery you have done the greater the risks  associated with the surgery and the greater potential that you will have complications.

My personal preference for patients like yourself is to remove the implants/breast implant capsules and perform breast lifting during one operation.  If the patient wishes to have implants replaced I would do so 3 to 6 months after the first operation.

I hope this helps.

Your 23 year old implants should be removed.  They appear hardened by a capsule and at this point in time are likely  to be ruptured.  After that you may choose to have a lift or not, and choose whether or not to have a new implant.  The lift will improve your shape.  You likely have more breast tissue now than you did 23 years ago so you could see how you feel without implant replacement..  If you choose to have a lift and implants the size will depend more on the biology of your tissues than on your preference.  A smaller size implant is a little safer for you.  I agree with the surgeon you saw in consultation.  An implant replacement without a lift will not look very good and is likely to look worse over time from the effects of gravity and tissue strain.

It does appear that your implants are above the muscle (the outline of the implants in the upper and medial regions of the breast are very visible), you have severe capsular contractures, and severe ptosis (sagging).  If you want to have implants, as removing them will leave you smaller than you want to be, and yet you want to be smaller than at present, you certainly can have smaller implants placed.  There is no question that you are in need of a significant breast lift if you want to have a good shape and contour to your breasts...and the smaller the implants, the looser your skin will be without a breast lift.  You say "Surgeons will not remove them without a lift", but what they mean that your breasts will look even worse than they do now without a lift. Your implants would look better if moved to a subpectoral (below the muscle location) if they are currently above the muscle.  The edges and possible wrinkles and folds of the implant will be better hidden, and the risk of a recurrent capsular contracture will be lessened.  Another issue is whether it is safe to do capsulectomies (removal of the contracted scar tissue surrounding each implant, which is necessary to treat the capsular contractures and lessen the risk of recurrence) and move your implants to below the muscle AND do a significant breast lift at the same time.  This would increase the risk of interfering with the blood supply to your nipples (which need to moved up quite a bit) and breast skin, and this could lead to skin and/or nipple loss. The thinner your tissues, the greater the risk. My recommendation would be to do the breast implant work first (capsulectomies and implant replacement with smaller implants moved to a subpectoral position), and then wait several months before performing the breast lift ("anchor" or inverted T scar pattern).