What is the best procedure to remove implants if autoimmune issues are a concern?

Implants produce a capsule around them and the capsule may be normal or not.  If a surgeon thinks the capsule is abnormal then it will need to be removed.  An abnormality may be calcification or infection.  Removing the capsule often removes volume and can injury blood and nerve supply.  It is best not to remove the capsule unless there is a good indication.  Another option may be to biopsy the capsule and them removal at a secondary occasion, if necessary.  Many women who undergo explant alone are often dissatisfied because of the hanging skin, empty appearance and require a lift.  I recommend explantation and lift using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained, if not injured during your previous surgery.  Later, fat transfers can be performed if additional volume is desired.Best Wishes,Gary Horndeski, M.D.

Calcific capsules or capsules that are distorting anatomy should probably be removed during the implant removal procedure.  Leaving a capsule behind is preferred if it is thin and pliable. If your implants are silicone, your PS may suggest that both the capsule and implant be removed en bloc.
The smaller the implant and the less the amount of time it has been since placement, the greater the chance the breasts will return to their preoperative state. It is very difficult to predict breast size following explant b/c breast implants, breastfeeding, and weight fluctuations over time tend to thin tissues, cause a decrease in size, and create more droop.  
Usually removing the implants and performing the lift at the same time makes the most sense as some patients clearly need a lift and only want to go through one surgery.  If you are borderline, it is not unreasonable to remove the implants and then observe a waiting period of six months before the determination for breast lift is made. This will give your breasts time to bounce back and your PS time to determine what type of lift, if any, or a breast fat transfer is necessary for you to reach your goals.

You can choose to have your implants removed with the capsules, especially if you have concerns about thick capsules. The longer you have breast implants and the bigger the implants are, the more thinning of your own breast tissue occurs. Plus, the implants have stretched your tissue as well. Breastfeeding also may change your breast size and shape. I would suggest meeting with a board certified plastic surgeon and discussing your concerns and options.