Hello dear, thanks for your question and provided information as well..
The breasts may lose their elasticity and firmness which can be caused by different factors such as pregnancy, massive weight loss, lactation and aging. To reaffirm the breasts and restore the natural look your surgeon can perform a mastopexy or breast lift. A breast lift restores a firmer, perkier, and more aesthetically pleasing shape to sagging breasts. This not only can improve a patient’s appearance by restoring her youthful, feminine proportions, but also help bras and swimsuits fit more comfortably and attractively. By removing excess, stretched out skin, reshaping the breast tissue, and raising the nipple & areola into a more forward position, a cosmetic surgeon can create a more youthful breast contour. Stretched, large areolae can also be reduced during breast lift surgery, creating an overall better proportioned, natural looking breast, Actually the perkiness on a person or another, depends on patients skin and breast tissue… Breast augmentation surgery increases or restores breast size using silicone gel implants, saline implants or in some cases, fat transfer. One of the most popular and frequently performed aesthetic surgery procedures, breast augmentation has a long and successful track record in satisfying women who wish to enhance, regain or restore balance to their figures.
I am surprised to hear that Medicare won't cover removal of what appears to be a ruptured implant because of the implant material. In my experience the implant material does not matter. Unfortunately Medicare will not pre-authorise any procedures. I would advise going ahead with the removal and maybe asking your surgeon to honor Medicare rates should coverage be denied and you become responsible for the charges. Good luck!
Medicare usually covers removal of old, especially ruptured, gel implants. A Mammagram or ultrasound may be needed prior to surgery. Medicare does not give prior approval, however, and will not cover replacement. I also have had several old saline implant removals, especially ones with thick hard capsules, covered by Medicare. You could also consider going to a university plastic surgery training program for removal.