I remember when Bully first got announced. They (Jack, and the media) made it sound like a columbine type thing, Which was basically looking at Rockstars catalog of games, which everyone was violent I guess. Needless to say the game wasn't about that, and it wasn't being a Bully either.
I really honestly think most developers could and can get by with most content if they tried. Yea you'll have a little trouble from media, moms, or whoever. But, that'll only happen if the game us uber successful though.
Look at the developer Running with scissors, 4 Postal games now. None have been banned. They aren't super successful, yet they retain more crude stuff that your most average violent games.
As far as removing things, yea it sucks especially in other countries. I feel like the US is pretty light on certain things. So we get to keep most of it, even then if it is removed you can still find a means to get it if you really want it bad enough.