Follow-up Question: What happens if the capsule is left in during explant?

The capsule is your body's response to your implants. It may contain silicone shell fragments, bacteria, calcification, and inflammatory cells which have been mobilized by your immune system to react to different components of the implant. Research has shown that the capsule does not disappear on its own when only the implant has been removed (See Nancy Hardt's paper in Plastic and Reconstructive Surgery.) In addition, if you have pain around the implants, it is usually due to the pulling effect of the scar on surrounding muscle and tissue. If you have health problems that could be from the presence of the implants, removal of the capsule is critical in improving your health. I encourage you to visit my website and watch my webinar series call "Breast Implants: Are They Worth The Risk?" 

The breast implant capsule will resorb with time but not completely resolve. If you have capsular contracture, the scar tissue may in fact harden and contract. Best, Dr. KaramanoukianLos Angeles

You ask a very good question. There are a few articles out there that claim that after implant removal, capsules will resorb on their own. While I do not completely agree with this, the presence of residual capsules does not cause any harm. There are good reasons not to do a capsulectomy after implant removal. The best reason is that complete removal is not easy and that keeping the capsules intact minimizes surrounding tissue damage. That is why most surgeons don't completely remove the capsule if there is no contracture.

If you just want to remove the implants because you no longer want them, and are having no issues with your breasts, you can just remove the implants. However, if you think you are having any medical problems potentially related to your implants, the capsules need to be removed as well. Your axillary incision cannot be used to remove the implants and capsules.

You do not have any signs that there is an inflammatory reactions to your implants( redness, pain, swelling, hardness or discharge) and that is the reason that you can leave your capsules behind. If you want to remove them you will need to have incision in your breast crease and the there will be breast deformity due to scaring . If you had ruptured silicone gel implants or severe capsular contracture capsule removal would have been indicated. I offer my patients fat grafting post implant removal. Please see the link

 Total capsulectomy is recommended if a patient wishes to recover her health. If a patient has saline implants with mold contamination and has the genetics so she cannot detox the biotoxin (25% of the population) removal of the entire scar capsule is needed along with several months of antifungals as well as biotoxin detoxification in order for the patient to regain her health.   If the patient has silicone leakage from the implant which is common with a history of trauma or implants older than eight years, then total capsulectomy as well as detoxification of silicone and chemicals, is important in order to remove the silicone in the capsule as well as the chemicals in the capsule which are both carcinogens and neurotoxins.  Very few plastic surgeons are aware of the Dow Corning engineering data or the list of chemicals Dow Corning provided in the Dow Corning lawsuits in the 1990s. The doctor must also be familiar with detoxification techniques which plastic surgeons are not familiar with for the most part.  They are also not familiar with the science of biofilms which form around the implant which can contain many different types of organisms that can contribute to breast implant illness.  If plastic surgeons were aware of biofilms, it would be obvious the total capsulectomy is needed to regain the patient's health. Yeast overgrowth in the body has been found in 100% of women with defective silicone implants due to a T cell immunity problem.   This information can be found online, but I am not allowed by real self to inform the patient of this, is they consider this self promotion.  The information that I have published is well documented with peer reviewed references in the medical literature.  The systemic fibromyalgia illness associated with  defective silicone implants, is also noted on the FDA website in an article published in the Journal of Rheumatology in a study that the FDA partially funded. Many doctors treating intracellular infections such as mycoplasma and Lymes disease, have found that removal of defective breast implants is essential in order to restore to restore T cell immunity important for fighting these infections. Several famous women including Hugh Hefner's wife have been in the news recently with this concern.   I have also found coinfections of multiple viruses and parasites as well as yeast, mold, and intracellular bacteria require treatment in order for the woman to regain her health.   Removal of silicone filled lower axillary lymph nodes is also important to help prevent silicone illness as well as the lymphoma risk with textured implants. I have found this lymphoma risk to be due to chemical toxicity along with mycotoxins from mold so treatment with several months of antifungals as well as chemical detox is important for women with these problems.   As both sick building syndrome or biotoxin disease from mold, as well as intracellular infections are politically incorrect at this time, your doctor probably knows very little about either disease. Dr. Feng's analysis of the capsule in her answer below is accurate but not well known by most plastic surgeons. 

If you have saline implants I am not sure why you think your implants are making you sick. Even silicone implants have not been shown to cause illness. Whatever the reason, you ask a good question. My current position on capsulectomies at the time of explantation has evolved through experience. If you have capsular contractures then definitely have the capsules removed as they can continue to contract abnormally and distort the shape of your breast. I used to think that if the breasts were soft I didn't need to remove the capsule until I had a patient who developed a contracture on one side after I removed her implants. Now I remove just the front side of the capsule; enough that the capsular fibers can't contract in a circular fashion. This is more than just scoring the capsule, but it only takes a few minutes and gives me some peace of mind.