There is not a general answer to the question. The appropriate recommendation depends upon the ratio of excess skin to breast tissue volume. It also depends upon whether the patient's goal is primarily size reduction, or mainly reshaping.  If size reduction is the main goal, an implant is not usually placed, since the improvement in shape would be offset by adding back volume.  If reshaping is the main goal, an implant to add to upper breast contour could be beneficial.

Breast Reduction

Silicone is essentially an inert material, and as such "rejection" does not occur. For practical purposes, the true "rejection" phenomenon refers only to protein matter, such as organ transplants.

Silicone can, however, cause mild irritation to the tissue (breast) that it contacts. Within four days of insertion of a silicone breast implant, the body forms a shell of scar around the implant as an isolation mechanism - surgeons refer to this scar shell as a "breast capsule". The characteristic of this scar capsule is that it may contract (tighten) around the breast implant to varying degrees. So in those patients whose “implants have gotten hard,” the actual implant has not hardened. Rather, the scar capsule has tightened around the implant, so that the breast feels hard. This hardening is referred to as “capsular contracture.”.

The frequency and degree of capsular contracture varies from one individual to another. It is not predictable. In general, patients who are going to develop capsular contracture often do so in the first few months after insertion. However, contracture can occur at any time during the life of the implant.

Botox Injection

It is impossible to give a patient-specific answer without direct examination, so I will respond in general terms.

The most common forms of cheek implants are shells of solid silicone. They are usually placed directly over the body of the zygomatic bone ("cheekbone"). The subcutaneous fat layer, overlying the cheekbones, is very thin. Over a period of years, it is not uncommon for the implant to create a thinning of the fat overlying the bone. In such a case, late removal can leave a depression at the site of the previous implant.

While there may be a difference in opinion as to whether to place the implants initially, once in place, it is usually better to leave them, unless they are causing problems. If removal is necessary, some form of additional cheek lift may be required, to compensate for the depression.

Facial Implants