Explant Allergan silicone textured implants 7yr old overs , think I have symptoms of BII capsulectomy necessary or not?

Leaving a capsule behind is preferred if it is thin and pliable. If there are calcific components, or silicone granulomatous material, or if the capsule is deforming the breast tissue, then removal of the capsule may be warranted. A number of scientific studies have demonstrated the safety of silicone implants; yet, many patients continue to have anxiety about their use.
On July 24, the FDA recalled Allergan BIOCELL TEXTURED breast implants because of the increased risk of anaplastic large cell lymphoma (ALCL). The data analysis performed by the FDA revealed showed that the risk of developing ALCL with Allergan’s implants was nearly 6 times the risk of developing the cancer from textured implants manufactured by other companies. BIA-ALCL is not a cancer of the breast tissue but a lymphatic cancer of the capsular tissue that forms around the breast implant.  The recall was based on reports of 573 cases of ALCL worldwide, including 33 deaths. Of all the cases, 481 had Allergan textured breast implants at the time of diagnosis. The FDA is not recommending that surgeons replace textured implants if patients have no symptoms.

Dear chakakhan4,
it is hard to tell for sure without an examination but generally speaking most plastic surgeons will try to remove capsule in case of capsular contracture or thick capsules. Otherwise pastic surgeons remove implants and leave the capsule inside. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

I do not perform capsulectomies unless there is indication, which is usually decided at surgery.  However, sometimes pre-operatively calcified capsules can be detected and will need removal.  I do caution you about not doing a lift.  After explantation, many women are dissatisfied with the empty looking breasts and sagging skin envelope.  Often times, they require a 2nd operation for a lift.  It would be better getting them done at the same time.  The technique I recommend is The Bellesoma Method.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can be performed if additional volume is desired.  Best Wishes,Gary Horndeski, M.D.

It is recommended, in a setting where there is concern for/suspicion of ALCL, that the capsule be removed. However, asymptomatic patients neither need their implants removed nor the capsule excised.
With regards to your specific question, Breast Implant Illness and silicone related medical complications/autoimmune disease are controversial topics. It is a phenomenon which is supported by a wealth of anecdotal data (patient testimony on the internet) but no empiric data (hard scientific research). Patients reports a litany of symptoms which they attribute to their implants but the connection is difficult if not impossible to prove via objective evidence (lab tests etc).
Physician scientists may recognize anecdotal data but unless it is supported by Class I empiric data, it is difficult to place a great deal of faith in it. Clinicians should make decisions based upon evidence based medicine as this is the best tool we have to evaluate new and emerging treatments and technologies. Any claim can be made about anything, but unless verified it is difficult to put too great a degree of stock in it. 
That being said, it is easier to identify what one knows rather than what one doesn't. What we do know is that by all available measures today...implants are safe and specifically silicone implants are safe.
Silicone breast implants are among the safest medical devices in use today. These devices are also among the most rigorously studied and tested medical devices currently being used in the U.S. today. It is biologically inert and in that respect no different than the titanium used for bony fixation. There has been no demonstrated link between silicone and the commonly cited myth of autoimmune disease.
BII is not (as of yet) been recognized as an actual phenomenon with a discernible link to silicone implants. As such, there is no recommendations regarding capsulectomy in this setting.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
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This is a very good question. If a patient expresses concern about the capsule and I can remove it safely, I will remove it using a precise dissection. There are potential complications to capsulectomy which you should discuss with your surgeon. ALCL is so rare, so there is no scientific data to support the need for removal of the capsule when removing textured implants but since this rare lymphoma develops in the capsule, to give the lowest risk of ALCL I try to remove the entire capsule if this can be performed safely. 

In my 32 year experience I remove the capsule when there are abnormalities. If there are calcifications, nodules or any abnormal thickness. See an experienced board certified plastic surgeon. Good luck. 

Based on the information provided you may want to consider having the capsules removed.  Typically if they are thin and not causing issues it is fine to leave them behind.  However you described that you have capsular contracture and other symptoms.  In this case it may be warranted to have them removed.

I am sorry to hear about your concerns after breast augmentation surgery.   Whether or not to perform capsulectomy at the time of breast implant removal surgery should be individualized, depending on the patient's unique clinical presentation.  Keep in mind that different plastic surgeons will have differing practices. What follows are my recommendations to patients, at this particular time: Clinical situations where capsulectomy is indicated include: capsules have thickened (and/or are otherwise symptomatic), are associated with the ruptured silicone gel breast implants,  the presence of older textured silicone gel breast implants or if the patient has concerns about "medical conditions" (breast implant illness concerns) related to the breast implants.   
  Patient should keep in mind that, capsulectomy can expose them to additional risks, such as bleeding, injury to surrounding tissues, removal of native tissue unnecessarily (leading to postoperative contour deformity), injury to the chest wall and/or pneumothorax.
  When it comes to determining the best course of action for every patient, nothing replaces the use of good judgment and individualized patient care. I hope this helps.