Breast implant removal via areola incision and periareolar lift at the same time? (Photo)

Good afternoon!
My approach in almost all cases is the following:
1) en bloc capsulectomy/explant
2) drain for five days
3) tight compression bra for 12 weeks
With this approach I almost never have to go back and perform a lift because the skin has such an amazing ability to "shrink back down" to your preop size and shape.

The lift you describe is helpful when only a minimal lift is needed. As you have had your implants for 18 years a donut lift may not be powerful enough to get you the shape you want.  See a board certified plastic surgeon in your area for a consultation.  Together you can create a surgical plan that's best for you.

As you have such a significant asymmetry I would advise explantation followed by 6-12 months of waiting, and then mastopexy/mastopexies as needed. Certainly the 2 could be done at the same time, which we’ve all done many times, but from experience I’d say there is a relatively high chance of need for revision in that scenario. Best of luck to you. 

Dear Optimistic981,
my preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity. 
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

The technique I recommend is explantation 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 and the ability to breast feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can be performed if additional volume is desired.Best Wishes,Gary Horndeski, M.D.