I have silicone implants with rupture. I want them removed en bloc, without replacement. No lift. Met with a doc, have concerns

  Thank you for the question.   En bloc breast implant removal refers to a procedure where the breast implant and the surrounding capsule is removed as a single unit.  The procedures is performed such that the contents within the breast implant capsule do not come into contact with the surrounding tissues.  Generally, the procedure requires a longer incision (6-7 centimeter) usually in the inframammary fold, in my experience.  Also, in my experience, the procedure is more successful when capsules are thickened as opposed to when patients are very thin (normal) capsules.  Also,  sometimes complete capsulectomy is not safely possible;  for example, breast implants place in the sub muscular position may have a capsule that can be  densely adherent to the patient's rib cage. Removal of this posterior capsule can be potentially dangerous.
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 (again), 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.In my practice, I use drains for patients 'sundergoing breast implant removal surgery.  
 Best wishes.

For explant surgery, it is almost always best to remove the capsule in its entirety.  This will allow the space to heal.  If you leave the capsule in place, it does not heal.  Fluid can accumulate in the space.  The situation that brings the patient to implant removal will have an affect on the decision.  This is a surgery which requires discussion with the plastic surgeon about the problem, the goals, and the technical concerns.  The body does not re-absorb the capsule.  Revision surgery requires drains because the fluid is going to be generated when you operate on the scar capsule.  If you provide a mechanism for the fluid to be removed (i.e. drains), the risks are lower.  If the fluid accumulates because there were no drains, it will most certainly cause problems in the future.

If your surgeon is not able to remove all free silicone via en bloc then he/she will attempt to remove as much remaining free silicone as possible.  The use of drains is done by surgeon preference.  If you are uncomfortable with what the surgeon has described to you, you may wish to seek a second opinion from another board certified plastic surgeon.  You want to be comfortable and confident as you go into surgery.