Should I be concerned with hole/foul smelling discharge on R breast after having textured Sientra gel implants removed. (photos)

The hole is not necessarily concerning on its own. When it is coupled with pus, foul smelling drainage or other red flags such as fever or chills it could indicate infection. It could also indicate a potential suture abscess which can be addressed in the surgeon's office. If it does not improve return to your surgeon for further evaluation.

A problem. Having the implants removed sometimes along with portions/all of the capsule needs to be performed at the same time in order for healing to happen properly. Other times the capsules can be left intact and the implants simply removed. Drains are always a game time decision and not always a must have. You need to see your surgeon to discuss prolonged healing/wound care instructions with him/her.

An exam is needed to determine the extent of the problem.   Discuss wound care with your  plastic surgeon.

You would of course need to be seen in person for an appropriate assessment. But, in general, have some drainage at this point is not in and of itself a major concern...but it could be if it does not heal on its own and/or if you have systemic problems (fever, chills, sweats, etc).  If it is an ongoing process then you may, in fact, need to have a procedure that removes the capsule itself.  That, however, is not a minor procedure and I would not advise that you rush into it.  But if the drainage continues and does not abate on its own, then surgical intervention may be indicated. If you have hesitations, you can seek additional opinions.I hope that this helps and good luck,Dr. Alan EnglerMember of #RealSelf500

This is most likely a problem.  It is important to have the entire capsule out as well as drains for about a week in order to heal properly.