Implants are not lifetime devices, I tell my patients.  They are man made.  There is much debate as to when to change older breast implants.  Honestly, the best way to check is to go see a Board Certified Plastic Surgeon.  If I were you, I would also take my latest mammogram if you have one to let him look at to assess if the implant is broken.  Most likely you have saline implants, based on your age.  You'll know when they break, as you will go flat.  You mention that you work out a lot.  If your implants were placed under the muscle, and you work out your chest a lot, that could possibly be the reason that they are now looking a bit funky, as the muscle building can change the height of the inframammary crease.  I have my patients come in every year after their implants are ten years old to evaluate the implant.  A physical exam will help with the story a lot.  

Good luck.

Breast Augmentation

 The best way to find a plastic surgeon, is to first check his/her credentials (but since you are on this site, you have already done that).  You want to make sure that he is Board Certified and does a lot of Aesthetic Surgery.  I would also suggest looking at his before and after pictures on the web (if there are any);  even more importantly, talk to some of his patients and also to some other patients who are happy with their results from other plastic surgeons.  Lastly, you should schedule a consultation with him to be seen.  See how well you feel about him, and get a sense of his honesty and commitment to excellent patient care.  I do believe that a Plastic Surgeon is the best choice to see, as he can do other things if he feels it is warranted, where the Dermatologist can not do surgical intervention.  Dermal fillers are usually the best option, but without seeing you it would be impossible to tell if another surgical option would be better for your situation.

Soft Tissue Fillers

Personally, I don’t believe that a capsulectomy (removal of the entire scar surrounding the implant) is safe to do at the same time as a lift. Too much of the blood supply can be affected, and I have seen complications of sloughing of tissue in these cases. So I believe that these should be staged for safety sake. That being said, and you can only tell once you have done an exam, you could do a capsulotomy if the breast isn't really hard (a grade 2 capsule). You can do a capsulotomy with a lift, as you are not involving the blood supply as much.

Insurance usually doesn’t help, as this was done for cosmetics in the past (if done for a reconstruction after mastectomy it is a different matter), but some times the insurance will help with the removal only. If you are putting another one back in, they will frequently deny it. Putting another implant back in is never covered (unless for reconstruction), and a lift will never be covered also unless it is a reconstruction.

I have seen some patients get a new credit card and place 0% interest for 6 months. That is the best financing I have seen. Other than that, a group called "Care Credit" has been recently introduced in many (and my) offices.

Breast Lift

I have not had a patient who had feeling in their nipple after having surgery, which then lost feeling 11 years later. Unfortunately, when the surgery is completed, if there is no feeling to the nipple after surgery, and it hasn’t returned in the next year, it is usually lost. This is more frequent with the periareolar incision (5 to 15 percent). The inframamary incision loses nipple sensation less (3 to 5 percent) and least with the armpit incision (1 to 3 percent).

Sorry, but if it is numb now, and has been for years, it probably will not come back.

Breast Augmentation

Yes, I would expect for your areola to increase in size some. This is variable depending on the size of the implants, and if placed under or over the muscle, and the properties of your own skin and elasticity of the skin. It is impossible to know exactly how much, but it would be wider.

Botox Injection