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.