“Implant illness” groups made me inundated w fear. Set to explant. (Smthsaline 13y). Why such dif opinions on caps removals?

I completely disagree with Dr Kolb. There is no scientific evidence that in someone with out any symptoms, that the capsules have to be removed. Removing a capsule, causes more injury (trauma) and bleeding for no additional benefit. If you have significant capsular contracture or a ruptured gel implant, then capsule removal makes sense. A submuscular capsule does NOT interfere with breast cancer detection and is not a risk factor for infection. Start with a consultation with an experienced board certified plastic surgeon. 

If you are having your implants removed under local anesthesia the capsules will be left behind. General anesthesia is recommended in order to remove both the implants and capsules. Typically capsules should be removed if there are issues with the implants including rupture, capsular contracture, etc. If there are no issues then it is optional to have the implants removed or leave them behind.

If you have smooth saline implants and are not ill, then just avoid mold and change out the implants every ten to fifteen years (depending on the manufacturer).  Removal under local which leaves the capsule can lead to complications later of seroma, difficulty with cancer detection, and infection.  If you want to remove your implants, the safest method is total capsulectomy, drains for 5 to 7 days, and compression for two weeks after drain removal.  I treat many patients who have just had their implants removed and later developed problems.  Most plastic surgeons do not understand biofilms and silicone and chemcial toxicity and the co infections associated with defective breast implants, so their opinions are not based on science.  Many plastic surgeons will say that capsules dissolve, and this is totally untrue.  In fact, in some cases, capsules can reform if there is fluid left in the chest wall even after removal just like with an abdominoplasty forming a capsule with a seroma.  If you are ill with symptoms of biotoxin disease, total capsulectomy alone will not be sufficient.  You also need rotating antifungals for several months as well as biotoxin detoxification.  The main chemical in the shell is methyl ethyl ketone which can cause Raynaud's disease by depleting arginine and nitric oxide.  Most women who do not have detoxificaton defects are able to detox this chemical so it is not a problem.  Some women have HLA types such as HLA B27 or HLA D53 that cannot tolerate silicone in any form and become ill with an autoimmune disease within weeks of implanting any implant.  Again there is a great deal of information in the peer reviewed scientific literature on silicone toxicity and adjuvant disease but is not common that plastic surgeons have read this literature.  I read this literature while writing a book on this subject and continue to follow the science.  I also work with professional toxicologists to develop detox programs to help women who are ill and professional mycologists to understand the role of mold in the biofilm.  Implant illness groups are often grossly misinformed about the actual disease and treatment and at least in some cases, give very poor advice as they do not understand the complexity of this disease.  Not all patients have the same problem and if co infections are not treated and toxicities are not treated, the women remain ill.