DCIS, lumpectomy needed, recommendations for sub pectoral implant replacement and symmetry?

Dear ORN93,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

For DCIS, treatment can be either lumpectomy or mastectomy. If you have lumpectomy, then radiation is typically required. But radiation can have detrimental effects on the skin and serious effects on past or future implants, thereby creating permanent asymmetry. If you have mastectomy, then you can have reconstructive surgery with implants. The advantage is that radiation is usually not necessary, but the disadvantage is that it creates some asymmetry to the other side. Since you already have implants, much of this asymmetry can be controlled. Or, if symmetry is very important to you, then you can consider have mastectomies on both sides, along with symmetrical implants on both sides. It is always best to talk through each scenario with your plastic surgeon, and breast surgeon, so that you can make an informed decision about what will be best for your situation. Best of luck!

Don’t mess around with this. By all means get a few opinions but watch and wait is not something that is standard of care in the United States

Go visit with a reconstructive breast surgeon and discuss your options. Your old implants can be replaced at the same time as the lumpectomy. You might even consider other options for the reconstructed breast.

A consideration would be to remove all the breast tissue including the DCIS and avoid the radiation which causes fibrosis of the tissue including the tissues around the implant. The 25 year old implants probably need to be changed out and slightly larger implants could be placed to make up for the tissue that would be removed. This operation would be considered reconstructive and not cosmetic and should be covered by your insurance, including a similar operation which you should consider on the contralateral breast to reduce your chances of developing breast cancer.