Breast implant surgery is consistently one of the most numerous aesthetic surgeries performed globally every year. Breast aging is affected by the structural changes in collagen and skin as well as glandular involution and the effects of pregnancy, breastfeeding, and menopausal hormonal and weight changes. This affects breast structure and intrinsic support that impacts implant-based surgery planning. A significant cohort of older esthetic breast surgery patients have had breast implants in situ for many years, also affecting breast structure. In this article, the authors discuss the impact of breast aging on esthetic breast implant surgery decision making.