Thinking about explanation. If I have BII isn't it necessary for the total capsulectomy or will explantation be ok?

Since
you implants were under the muscle, the posterior capsule is firmly attached to
the underlying ribs.  If the capsule is
very thin and not infected, the capsule can remain.  Attempting to remove capsules can result in
bleeding and injury to the underlying muscle, ribs and possible pneumothorax, although
it is very rare.  The surgeon will decide
what is necessary.  The other thing to
think about after explantation is the excess skin.  You will probably need a lift and the
technique I recommend is The Bellesoma Method. 
This technique reshapes your breast tissue creating upper pole fullness
without implants, elevates 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. 
Simple explantation can be done under local anesthesia but capsulectomy
and lift will require general anesthesia. 
Best Wishes,Gary Horndeski, M.D.

Thank you for sharing your question and I am sorry to hear of your health issues.  In most cases I advocate for removal of the implants and their surrounding scar tissue to leave only your native breast tissue.  It will depend on the quality, appearance, and feel of your specific implants, however.  

Dear amdelarosa:     Thank you for your questions. I am sorry to hear about the problems you are experiencing.  Keep in mind that you are asking a question that is currently controversial;  do not be surprise if you received very different responses from different sources and if responses change over the course of the next few years.
 Some general thoughts may be helpful to you.
There are a very small subset of patients who feel that their breast implants contribute to a variety of illnesses.  This phenomenon has been discussed since the 1960s and has been termed human adjuvant disease, silicone induced human adjuvant disease, autoimmune/inflammatory syndrome induced by adjuvants and silicone implant incompatibility syndrome. Today, systemic symptoms possibly associated with silicone breast implants involve the central nervous system, musculoskeletal system, immune and inflammatory systems, GI and GU systems, psychological system, and the cardiorespiratory sound systems. The term breast implant illness is being used to describe the variety of  symptoms thought to be possibly associated with silicone breast implants.
 You will find, that there is no consensus among plastic surgeons, whether or not there is a link between breast implants and the medical conditions of concern.   In other words, as of today, there is no scientific "causation" shown thus far.  The main theory currently involves a complex interaction of breast implant material with the patient's immune system,  Involvement of bacteria/mycobacteria/fungal/virus/other adjuvants (known as Biofilms) as well as the patient's specific genetic makeup. It is theorized that the "wrong combination" of these parameters may lead to autoimmune disease and/or other associated systemic symptoms.   
However, personally  having worked with many patients who have presented with concerns regarding breast implant illness, I think (as thoughtful and humble) physicians, it is important to keep an open mind (even though there is no definitive scientific demonstration of breast implants and specific illnesses except for a very rare lymphoma) and remember (again) that we may very likely  not have a full understanding of breast implants and the potential interactions that may occur with each patient's unique biology.   It is clear, based on the literature and my own anecdotal experience, that a significant percentage of patients who undergo breast implant removal surgery (and capsulectomy)  do experience improvement in symptomatology. On the other hand, a similarly significant percentage of patients continue to  experience symptoms despite breast implant removal/capsulectomy surgery.
Generally, I encourage patients in my practice who have concerns about "breast implant illness" to undergo complete medical workups, and seek second/third opinions (internists, neurologists, rheumatologists, endocrinologists...) as needed. I believe in my heart that if these problems are caused by a Biofilm it is best to remove the entire capsule. I try to do this in an en bloc fashion if possible. Good luck and I hope this helps!
 

Typically if you are having no issues with the implants or capsules, it is fine to remove only the implants and leave the capsules behind.  However if you are concerned that you may be experiencing health issues due to the implants I would recommend removing both the capsules and implants for your peace of mind.

Hi amdelarosaou I think the best way to put this is that BII is controversial.  Years and years of research using unbiased good scientific technique has failed to find a relationship to any illness caused by the implants.That said, if you feel anxious about the implants, it is reasonable to remove them.  Given that it is not proven that BII truly exists, or that removal will give you relief in the event that it is real, I would recommend that you get the implant out without addressing the capsule.  I would allow enough time for healing (say, 6 months or so) before deciding if this does the trick.After an adequate time of healing, you feel that you are not relieved, consider a larger, much more involved procedure- capsulectomy.Alternatively, if you are convinced that you must get the capsule out, that would be acceptable.Best to you.sekl

Thank you for the question.  Generally speaking (in my opinion), unless the breast implant capsules have thickened (and/or are otherwise symptomatic), are associated with the ruptured silicone gel breast implants, or if the patient has concerns about "medical conditions" related to the breast implants, capsulectomy is not universally necessary. For these patients, en bloc removal of breast implants is a good procedure.

On the contrary, capsulectomy can expose patients to additional risks, such as bleeding, size loss, contour irregularities and other serious complications. In other words, any maneuver performed during surgery exposes patients to additional risk (morbidity). For example, attempting to remove very thin capsule densely adherent to the patient's rib cage may expose the patient to significant bleeding and/or entrance into the thoracic cavity.

My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as well. Working together you will come up with a good plan to achieve your goals.  

  I hope this helps. Best wishes.

I do recommend a full capsulectomy.  I find it works the best to get out all the scar tissue. You don’t want to keep scar tissue because it can develop a seroma or fluid .   Best to get the opinion of a board certified plastic surgeon for an in person consultation.  Good luck 

If there are symptoms then the capsule can be removed.  In order to do an enblock a larger incision needs to be made in the fold to remove the implant.  Otherwise a complete capsulectomy can be done through an existing inframammary fold incision or a 5cm incision.

Before you remove your implants for medical issues, you might want to be checked for food allergies. Food allergies are very common, often ignored, and can cause a wide range of symptoms. Typically, if your capsules are very thin, many doctors will leave them to avoid more tissue damage. if you have signs of infection or hardness, the capsules need to be removed.

Peer reviewed literature supports total capsulectomy in order to avoid complications later.  I often have to remove capsules in order to treat any underlying problem but also antifungals, detoxificaton, and treatment of any co infections may be important to regain your health.  The endocrine system can be disrupted at the hypothalamic level by biotoxins if you have a mold contamination in or around your implants.  Some patients have an autoimmune thyroid issue from the silicone shell as well plus other silicone in the environment.