Removal of 20 year old textured implants required: what are the risks?

It is likely that your breasts are low on the chest wall.  If you simply undergo explant alone you will have hanging skin and an empty appearance.  You will need a lift as a secondary procedure.  You are better off doing them both at the same time.  The technique I recommend is explantation and lift using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained, if not injured during your previous surgery.  Best Wishes,Gary Horndeski, M.D.

Thank you for sharing your excellent question.  There is a significant amount of misinformation currently taking place with implants but current consensus is that if you are not having and difficulties, or changes, with your implants, you need not have them removed or replaced.  Hope this helps.

Dear Miles33,
it is hard to predict how will your breasts look if you remove your implants. There are no recommendations for removal of textured implants in asymptomatic patients. In case of textured implants, they are harder to remove than smooth implants. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Breast implants do not need to be removed if there are no problems with your breasts or your breast implants. The FDA has not recommended removal or replacement of textured breast
implants or tissue expanders in asymptomatic patients.  Textured
implants could be more difficult to remove because of the friction
caused between the implant and the muscle surface.  Leaving
a capsule behind is preferred if it is thin and pliable. If there are
calcific components, or silicone granulomatous material, or if the
capsule is deforming the breast tissue, then removal of the capsule may
be warranted.  If the capsule is left behind, the body will break down
and remodel the scar tissue on its own.
The smaller the
implant and the less the amount of time it has been since placement, the
greater the chance the breasts will return to their preoperative state.
It is very difficult to predict breast size following explant b/c
breast implants and weight fluctuations over time tend to thin tissues,
cause a decrease in size, and create more droop.  
It is not unreasonable to remove the implants and then observe a
waiting period of six months before the determination for breast lift is
made. This will give your breasts time to bounce back and your PS time
to determine what type of lift, if any, is needed.

If you are not having any issues, then you can elect to do the removal when it is a good time for you. If you have not had a recent mammagram, I would suggest getting one to also check your implants. The old gel implants could be leaking after 20 years. If your implants are saline, they can be removed whenever you like.

If you are not having any issues with your implants, removing them is not necessary. You will likely have loose skin and saggy breasts if you do have them removed. You may thereafter from a breast lift, if you choose to have your implants removed.

If you are not having issues with your implants and you still like them there is no need to remove them.  If you elect to have them removed you will likely have loose skin.  Your skin will contract to some degree during healing, but without an examination it is difficult to say how much to expect.  

Thank you for the question.  
 
Generally speaking, what your breasts will look like after explantation depends on several factors such as: the quality of skin elasticity (the better the elasticity the better the skin will bounce back), the size of the implants used (the larger the implant the more trouble you may have with redundant skin), and the amount of breast tissue present at this time (which may have changed since the time of your breast augmentation).
Life experience since your breast augmentation procedure, such as pregnancy or weight gain weight loss, will potentially influence the factors discussed above. If you take these factors into consideration and apply them to your specific circumstances you may get a good idea of what to expect after the implants are removed.Whether to lift breasts at the same time as   removal of breast implants or "stage" the procedures is a decision that is best individualized.   Every patient starts out with different anatomy, different goals/expectations, as well as different  preferences/goals…
 I have found in my practice, that when breast lifting surgery is definitely going to be necessary in order to achieve an aesthetically pleasing outcome, MOST patients prefer to have the breast lifting performed at the time of breast implant removal.   Most patients simply do not wish to undergo two operations, if avoidable.
 On the other hand, there are patients who (where safety considerations such as potential for loss of blood supply to tissues…), benefit from a two-stage approach.   For example, there are patients who benefit from the following operation: removal of breast implants and capsulectomy surgery,  if indicated based on the patient's clinical situation and examination (in the first stage).  A second stage breast lift may be more accurately planned and more safely executed.
 
  
In "borderline" cases where there is doubt whether breast lifting is necessary or not, I advise patients to undergo explantation only and to give their breasts the benefit of the doubt  before deciding whether breast lifting would be beneficial.  Patience is definitely indicated after removal of breast implants; it will take many months/year for the skin to “bounce back” and for you to see the final appearance of the breasts.
 
 As you can see, there is much to consider (which is why nothing replaces individualized care,  centered on good communication and good judgment, provided by a well experienced board-certified plastic surgeon). 
My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as well. Working together you will come up with a good plan to achieve your goals.  
Best wishes.

If you are not having problems, then there is no emergency for implant removal.   Since the implants are old, I would consider removal in the future.  Wearing a compression bra will assist in healing.