I've read it's not safe to leave the capsule behind after breast explant because of BII. What are your thoughts on this?

Thank you for your question. The recent increase in reports of BIA-ALCL (Breast implant associated anaplastic large cell lymphoma)  which is a rare kind of lymphoma that can develop in the scar tissue around the implant, has led to change the approach in the treatments of capsules. In the past there was no indication in removing a thin and normal capsule, where there has always been an indication in removing a thickened, calcified capsule. If the implants removed are textured, it is now considered preferable, when surgically possible, to perform a total capsulectomy (to remove the entire capsule) so that the risk of the onset of BIA-ALCL is nearly erased. If however the old implants are smooth and the capsules appear normal, there is no indication to remove it as the BIA-ALCL seems only related to textured implant. Hope it helps.All the bestAndrea MarandoPlastic and Cosmetic Surgeon, Manchester and London, UK

Capsulectomy is only warranted/indicated in a few situations:
-Capsular contracture
-Ruptured silicone implants
-Suspicion of BIA-ALCL in the setting of a textured device (late fluid collection with ALK+ and CD30+ lymphocytes present)
A thin, soft (non-calcified) capsule in the setting of an intact silicone implant does not necessitate removal. Following explantation, it will simply shrink down. However, high grade firm/calcified capsules will remain so if not removed. In the absence of the implant this remain palpable and may be a source of discomfort.
As always,discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
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Unless there is a specific reason to remove the capsule, like an old gel implant rupture, or possibly a textured implant, or calcification in the capsule, the capsule is your own tissue and can remain. Sometimes if the capsule is very thin, more damage is done with trying to remove the capsule than leaving it. Also, if the breast tissue is very thin, keeping the extra tissue of the capsule is helpful.