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

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.

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.