Q. I am 66 years old and had a breast augmentation more than 25 years ago. I have silicone implants.  My breasts are now very hard and misshaped.  I would like my implants removed but am terrified about how my breasts will look after all these years.  What should I do about these implants?

A. There are two issues that you are facing, should I remove my implants and/or should I replace my implants.  The answer to the first question is yes, you should remove your implants. They are old and are beyond their expected life cycle.  As a matter of fact, with the new silicone implants that are being used today, the recommendation is to replace the implants about every 12-15 years.  The other reason to remove them is that your breasts are hard and misshapen.  That is not normal and you should not have to live with breasts that are not normal in appearance or feel.  You have had a good run but now in light of the abnormal look and feel of your breasts, it is time to remove your implants.

The surgery to remove them is performed under general anesthesia.  The complexity of the procedure is affected by whether they are under or on top of the pectoralis muscle and whether the implants have leaked.  Implants that are under the muscle and ones that have leaked are more challenging to remove.  You should see a board certified plastic surgeon who is experienced in removing silicone gel implants because experience does matter in this surgery. 

Once you have decided to remove them, the next question that has to be answered is whether to put new ones back in or not.  This decision is totally up to you and should be based on factors such as your age, whether you are willing to go through changing your implants again in the future, how much natural breast tissue you have, and whether you can be happy with smaller breasts.  The biggest fear that women who are removing their implants have is whether their breasts will look deformed after the surgery.  The answer to this question is based on how much natural breast tissue is present.  If there is about 1.5 to 2 inches of breast tissue deep to the nipple area when the skin is pinched, then there will not likely be a deformity of the breasts after removal.  The breasts obviously will be smaller and may be saggy, but typically there is not going to be any significant deformity of shape.  In my practice I have explanted a large number of patients over the years, and in most cases the patients have opted not to replace their implants.  The majority of these patients (95%) were happy with that decision and never regretted it.  The few patients who did have second thoughts came back at a later date and new implants were placed. If a patient is on the fence about whether to replace the implant or not, I always recommend not replacing until the patient has had an opportunity to experience life without them.  Most of the time, patients will decide not to replace.