Possible erosion into the capsule causing a hematoma
It is unusual to build up fluid around an implant at 7 years post op. I have seen an implant erode into the capsule and cause bleeding. This may be the source of your problem.
Treatment of fluid buildup
Removing the capsule helps to minimize the risk of fluid recurrence, however if you are a thin person this process will further thin out your breasts and that can be detrimental if you have breast implants.
If you have a seroma (serous body fluid) collection and not a rupture implant, it may still be advantageous to take it out, allow the breast to heal completely and the seroma cavity to close and then come back later and place an implant into a new space.
Martin Jugenburg, MD
Breast implant replacement with capsules
I would probably not remove the entire capsule, esp if there is no problem or it does not look bad for it will thin the amount of tissue between the outside and your implant, esp if the implant is on top of the muscle. I would also recommend placing a silicine implant to give you probably a better cosmetic result.
Ruptured saline implants should be removed
If you have ruptured breast implant devices, whether saline or silicone, they should be removed. Usually if the surrounding capsule is thin and pliable (and not contracted), it may be left intact. In cases where the implant rupture may be the result of an advanced capsular contracture, then the capsule (some or all) should usually be removed. Whether you choose to replace your ruptured device with another implant is a separate issue.
Fluid collection around implants
A fluid collection usually indicates rupture of the implant or infection - in either event the implant needs to be removed. With a ruptured saline implant, the fluid usually gets absorbed. Whether the capsule is removed or not depends on a number of factors including surgeon's preference. It will be easier to advise on the last point by examining a patient or at least with more information.
Certainly either option is viable, my preference is to remove the capsule if possible. However you noted there is a fluid buildup. Is this fluid between the capsule, or elsewhere. If it is between the capsule, when the fluid is removed at the time of surgery, the surgeon must send this fluid to be examined for cytology. There have been rare examples when these cells have proven to be atypical. Getting back your original question, both approaches are sound, and are reasonable.
Not really understanding some points...your clarification necessary
You mentioned that you have saline implants for 7 years, yet they are ruptured with fluid and swelling. Saline ruptures lead to deflation and their treatment is by replacement usually with assistance of the manufacturer provided the parameter of the warranty are followed.
Silicone is a different matter. 7 years ago there was a moratorium on their placement. Ruptures silicones should probably be removed.
If you are having exchange of implant, then either a pocket exchange or capsulectomy would be wise since the capsules are thick according to your imaging studies.
Chen Lee, MD, MSc, FRCSC, FACS
Ruptured implant should be removed. Breast implants are meant to be in a shell, not free silicone.
Thick capsule, remove it, it is bigger surgery but patient safety is priority.