CONFUSED! Is a capsulectomy (partial/full) or no capsulectomy necessary when removing silicone breast implants? Pros and Cons?

The short answer is "yes", you do need a complete capsulectomy.  The pain in your right breast is probably nerve endings trapped in your capsule.  If the capsule is not removed, this may continue.  Also, if no capsule is removed in a breast explantation, this leaves a pocket which can fill with body fluids or even blood which could lead to its own set of complications.If the implant is below the muscle, removing the portion of the capsule attached to the ribs can be tricky but not for an experienced Board Certified plastic surgeon.  The bleeding encountered in a capsulectomy can be easily treated with intra-operative hemostatic agents and a drain.  The pros of removing a capsule at the time of explantation very much outweigh any negatives. 

Whether or not an operation is associated with pain is not a way to determine if it is indicated.  If you have a capsule that at the time of surgery needs to be removed, it should be removed.   The surgical pain is temporary.

Removal of breast implants, intact or ruptured, may have positive implications if patients are symptomatic. A constellation of symptoms associated with breast implant illness, and autoimmune disease are considered when treating patients who have breast implants and are concerned about foreign body reaction. In our office, we begin this journey with a consideration of symptoms and exclusion of obvious autoimmune problems. In many of our patients, en bloc removal of breast implants with capsulectomy is important and beneficial. Further clinical evidence about breast implant illness is evolving and will continue to guide treatment. I would suggest removal if there is a possibility of foreign body reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

This is hard to answer without an exam, for example to see if you have a trigger point. In general if your capsule is thin (breast implants soft on exam), it is not required. If your silicone implant is ruptured, however, then a capsulectomy to remove traces of silicone is often done. In either event pain is a complicated issue and you may or may not have pain after surgery regardless of the procedure. Always select the best plastic surgeon possible  (see below link).

If the capsule is thin and almost nonexistent I do not believe this needs to be removed. If you capsule is thick then I would recommend partial removal.

Generally speaking, unless the breast implant capsules have thickened and/or are otherwise symptomatic (pain in your case), there is no indication to have them removed.  On the contrary (unless indicated), capsulectomy can expose you to additional risks, such as bleeding and some breast size loss.  Your plastic surgeon, based on your physical examination, will  be able to inform you whether the breast implant capsule is thickened or abnormal.
Having said that, I often remove a small segment of capsule tissue when removing breast implants ( even when not encapsulated) with the hope that this maneuver will help with fluid resorption (and help prevent seroma formation). I usually use drains also.
What your breasts will look like after explantation depends on several factors such as: the quality of skin elasticity (the better the elasticity the better the skin will bounce back), the size of the implants used (the larger the implant the more trouble you may have with redundant skin), and the amount of breast tissue present at this time (which may have changed since the time of your breast augmentation).
Life experience since your breast augmentation procedure, such as pregnancy or weight gain weight loss, will potentially influence the factors discussed above. If you take these factors into consideration and apply them to your specific circumstances you may get a good idea of what to expect after the implants are removed.
Patience is definitely indicated after removal of breast implants; it will take many months for the skin to “bounce back” and for you to see the final appearance of the breasts. Best wishes. 

In my experience with over 1000 explantations, it is important to remove the entire capsule, treat with culture specific antibiotics as well as antifungals, as well as support immune system and endocrine system during the treatment process as well as detoxification if needed.  Please see the information including the book I wrote on the subject on the Internet.