My patients have taught me that often the happiest day of a woman's life is when she gets her implants and the 2nd is when she removes them. A PS must assess and instruct the patient whether the procedure will be simple or complex but irregardless of what surgical plans are proposed, part of our job is to counsel the patient on some of the psychological challenges which they may encounter. I have heard comments as diverse as " I never made friends with them", "I don't want to do the maintenance", "I'm financially strapped from trying to fix the hardness, position, etc." These motivations still don't console the patient that they need to endure another operation, with aesthetic outcomes, which are different from those which led them to the original surgery.
Here is my approach to removal of implants, starting from simple to complex. The algorithm doesn't replace a formal consultation, which is an opportunity for a patient to determine whether the PS has the requisite credentials and rapport for them. In general, if the patient doesn't have significant capsular contracture (scar) around the implants, the quality of the skin is elastic and the volume isn't excessive, the "solution" may be as simple as removal of the implant, compressing the skin brassiere and activity restriction to safeguard against "seroma" fluid accumulation, which is most common in the first 2 weeks following explantation. In theory, saline implants can be removed under local. By contrast, I recommend sedation for removal of silicone implants, to avoid the possibility of "silent rupture" clean up.
If there is sufficient capsular contracture to cause pain, distortion and asymmetry of the breasts, then sedation is preferable and drains will be used. Recovery is extended by approximately a week, while drainage decreases. The same post-op restrictions including activity restriction and use of a snug compression bra should be observed to assist in skin retraction (shrinkage).
The most difficult scenario is when both capsular contracture and ptosis (skin excess exists). Without removal of the dense fibrous capsule, it is unlikely that the space, which was formerly occupied by the implant will become obliterated, adhering down to the chest wall. While some patients choose both capsulectomy and mastopexy (breast lift) simultaneously, others will "stage" the removal of the scar tissue, first, compress the skin brassiere and request a lift, after a minimum of 90days.
Ultimately, like everything else, it is a deeply personal choice. I have been fortunate to have some of the RealSelf community entrust their care to me and for this I am indeed grateful.