What is the healthiest option for explant without replacement, a capsulectomy or capsulotomy?

The capsule is your body's response to your implants. It may contain silicone gel, 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've linked my en bloc video.

My rule of thumb is that if your implants are soft and not ruptured (silicone) then a capsulectomy is not needed and serves no key purpose. If you have ruptured silicone implants, then removal of residual silicone occurs when the capsules are removed. 

Neither a capsulectomy or capsulotomy is necessary if you are just having your implants removed. A Capsulectomy may be needed if you are having capsular contracture with pain. In that case the capsule is removed in order to alleviate the potential involvement of the capsule in causing pain. Otherwise, you can have your implant removed through a simple procedure. Best of luck.

It all depends on the capsule.  If you have a soft capsule that is not thickened and not bothersome, then leaving it alone and closing the pocket is more than sufficient and appropriate.

It is very controversial as to whether the entire capsule is necessary to be removed. It really depends on the severity of scar tissue with deformity and the amount of native tissue still available for tissue coverage .

A capsulectomy is the removal of the capsule that has formed around your breast implant. A capsulotomy is a release of the capsule without removal. The release is performed by making a series of cuts in the capsule allowing it to reexpand and relax. Removal of the capsule is not required unless the capsule has become thick and/or calcified. Release of the capsule in the performance of a capsulotomy is usually not required. Good luck

If the patient has very small amount of tissue, just a posterior capsulectomy could  be performed. Anterior and posterior capsulectomies will allow for better adhesion of tissues. No doing capsulectomy at al,l increases chances of fluid collection or seroma. 

Removing old breast implants can be a difficult decision. If you have not had any problems with your implants and still enjoy the look and feel of the implants, then by all means keep them. Some implants last 20-30 years without any problems. However, here is a list of conditions that one might consider removing implants for:leaking, broken or ruptured implantsswitching from saline to siliconegoing larger in sizegoing smaller in sizeswitching from above the muscle to below the muscleswitching from below the muscle to above the muscle relieving capsular contracture (hardening of the implant)re positioning the implant (up, down, side to side)any combination of the aboveSaline implant ruptures are easy to diagnose, they will become flat within 24-48 hours of leaking, as they are just like a water balloon. The saline is absorbed by the body and it is not harmful. Silicone implants are harder to diagnose if ruptured. Diagnostic studies such as a mammogram, ultrasound or MRI is sometimes needed. Newer silicone implants do not leak silicone, they are gummy, not liquid-like. The much older silicone implants (prior to 1992) can and do leak silicone and should be replaced if broken.Contour deformities caused by implants shifting, weight gain, weight lost, breast feeding, pregnancy, other breast surgeries can also lead to breast implant revision/replacement surgery.Typically, remove and replace procedures are quick outpatient procedures with fast recovery times. Much quicker recovery than the original procedure. If extensive removal of capsules or addition of Alloderm (acellular dermal matrix) is needed, drains may be placed to help with the healing process, and the recovery is longer.If loose skin is a problem and a breast lift is contemplated, staged procedures might be needed. Saline implants can be deflated in the office setting to allow the breast skin to redrape, this will determine if a lift procedure is needed. Silicone implants may need to be removed to allow for an adequate lifting procedure.Always visit with a Board Certified Plastic Surgeon with experience in breast surgery to determine what the best approach is for you.Based on the information presented, I would recommend the following:Removing the breast implants alone.  It is not necessary to remove the capsules unless there is some type of issue with the capsule.Good Luck!

It is not always necessary to perform a capsulectomy when performing an explantation.  If a patient has very little remaining breast tissue then the thin capsule can provide some extra shape to the breasts.  If the patient has a lot of scar tissue (encapsulation) then a capsulectomy is often indicated.  Make an appointment with a board certified plastic surgeon who performs a lot of revision breast surgery.  Best of luck to you

In a breast implant removal surgery, it is simply not necessary to do a capsulectomy.With every breast augmentation, the body forms a  protective capsule around theimplant.  In some cases, the body produces more collagen fibers than normal whichresults in a capsular contracture which tightens and squeezes the implant.  A capsulectomy is the removal of this capsule.  A capsulotomy is a partial removaland sometimes "scoring" of the capsule to release the contracture.  So again,I will say, that it is not necessary to do a capsulectomy.