Ryan Couvillion, MD

In general, I use drains when doing an explantation, especially when performing a capsulectomy.

I like to explain it like this - The implant has created a cavity that the body needs time to heal.  The drain helps to remove any extra fluid that the body puts into this space during the healing process.

Drains cannot completely prevent a seroma, but they can decrease the chance of it happening.

The drains are usually present for about a week, but this time period varies by how much is draining.  

Performing a capsulectomy at the time of implant removal really has to be tailored for each specific patient.  The information needed includes the patient's examination, implant status (ruptured or not), capsular contracture, pain or any other symptoms.  

The general reasons that capsules are removed are due to capsular contracture or for ruptured silicone implants.  They also are often removed by patient request.  A total capsulectomy has a higher risk of complications than leaving a capsule in place, as it's additional surgery.  Removing a portion of the capsule may be done to decrease the chance of a fluid collection after surgery.

In your situation with saline implants, no pain and no capsular contracture, removing your capsules likely isn't required.  

Removing leaking/ruptured implants (and often the capsule that they are in) is usually advised.  The decision about what to do after that is completely up to you.  Replacing the implants with new implants is a good option if you are happy with the current appearance of your breasts.  If you did desire a lift, they are usually well tolerated from a pain perspective.  

When considering the risk of additional surgery, your overall health status is usually more important than your age.  

Your saline implants should be able to be drained and removed through your previous incisions.  This can be done with numbing injections in an office setting.  

If you have capsules that you would like removed, an incision underneath the breast is the generally accepted approach.  This allows for most or all of the capsule to be removed safely.  I recommend that you meet with a plastic surgeon in your area and discuss your options. 

Removing the capsule surrounding a breast implant is usually done if there is a problem - contracture, pain, malposition, silicone implant rupture, etc.  That said, patients often request that the capsule be removed.  To take the capsule out en-bloc requires a larger incision than taking the implant and capsule out separately.  Removing the entire capsule also has a larger chance of complications such as hematoma.  

The decision of what to do needs to be made as part of an in-person discussion with a plastic surgeon after a good examination.