This lady has previously had PIP implants performed elsewhere and has had a rupture on the right side. She lived with rupture for some time and then developed joint pain, rheumatoid disease and late stage seroma. The concerns with late stage seroma are the development of ALCL. Surgery for cases such as this should involve a careful discussion about the pros and cons of removal only and the benefits of removal and replacement +/- lift. Surgery involved total capsulectomy and replacement. Seroma fluid needs to be examined and the capsules sent for histological evaluation. In this scenario all histology and fluid assessment was normal and the postop images are taken at 2 months postop after everything has settled. She has since removal and replacement found that the joint pains have resolved. This however cannot be guaranteed and patients need to carefully go through the pros and cons of removal only in this scenario.