Thank you for the question. Don't be surprised if you receive a variety of differing responses. 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 block removal of breast implants is a good procedure.When it comes to deciding which operation you should undergo: much will depend on your physical examination ( factors such as degree of breast ptosis, current position of breast implants, number of previous operations, assessment of breast skin quality/elasticity…) and your plastic surgeons' clinical judgment. Reviewing your photographs, demonstrating some asymmetric breast ptosis, it is likely that some type of breast lifting will be necessary both for improvement of breast position as well as breast symmetry. Longer answer: in person consultation will be necessary to provide you with precise advice. The main issue of concern is adequacy of blood flow given the extensive breast surgery planned. In my opinion, if the degree of breast lifting ( distance of movement of the nipple/areola complexes) is significant, then you may be better off having the procedure performed in 2 stages. If the degree of breast lifting is relatively small ( shorter distance of movement of the nipple/areola complexes) then it is likely that the procedure can be performed in one stage. If in doubt, in my opinion, the two stage approach is safer. In "borderline" cases where there is doubt whether breast lifting is necessary or not, I advise patients to undergo explantation only and to give their breasts the benefit of the doubt (allow for about six months to pass after breast implant removal) before deciding whether breast lifting would be beneficial. I hope this, and the attached link (dedicated to breast implant removal surgery concerns) helps. Best wishes. I hope this, and the attached link, helps. Best wishes.