Danielle Atwood, MD, PhD

Office setting versus OR should not matter as long as there is a dedicated procedure room in the office. I remove implants in our in office procedure room under local anesthesia under the same sterile conditions as in the operating room. The same sterilized tools and precautions are taken to ensure nothing is contaminated.
I would not, however, place implants under only local anesthetic due to the risks of patients moving or contaminating the sterile field, and the inability to provide full pain relief, especially if the implants were placed under the muscle and required a bit of dissection.
Infections can happen in any location with even the best sterile technique, however you want to make sure your surgeon is using all available resources at any location to reduce infection rates.

Hello,

From the photos (would need an exam with measurements) it appears you do not have enough ptosis/sagginess to do a full lift, particularly on the smaller side (which appears to be your right).

If subtle volume is what you are going for, I would recommend fat transfer, if you have enough to donate. If so, you could do fat transfer with or without a peri-areolar lift on the larger side to get more symmetry in regards to nipple position. The peri-areolar lift may not even be needed once you add volume to the smaller side as the nipples may even out. Again this could be better discerned at an in person exam. With fat transfer, you have to be aware that only 60-80% will survive, and to get larger increases in volume, you may need multiple staged procedures - usually 2 will suffice, but sometimes more.

Good luck!

Hello,

Your breast has a deformity commonly known as tuberous breast. Unfortunately, many surgeons resort to implants which I would not recommend for you (and you don't want in the first place). What I would suggest is a peri-areolar lift with areolar reduction which at the same time addresses lowering the inframammary fold and thereby improving or completely correcting the deformity (constricted breast base, elevated fold, NAC herniation). At this stage, you can also do fat transfer to the breast and medial cleavage to provide the look of the breast bases being closer together.

In my experience, this procedure has excellent results and almost complete resolution of deformity. You should be aware that about 60-80% of fat will survive, so if a large increase in volume is what you are after, that will take multiple stages.

Good luck!

Hello,

Congratulations on the baby!

If you were my patient, I would ask you to wait until at least 6 months or more after ending breastfeeding. The first concern would be that the breast parenchyma and ducts can be damaged causing milk to leak and collect in your breast which could become infected leading to abscesses or mastitis. This could also alter you ability to breastfeed if that is what you desire. And finally, we can't predict how breastfeeding will affect every breast, some worse than others. It is good to give it time to settle and deflate as much as it is going to before altering the breast.

Hello,

Issue #1: To know for sure, you would need a full exam of your abdomen and thighs to make sure you have enough fat to donate. For 600cc of fat per breast you need to be able to harvest that and more from donor sites.

Issue #2: 600cc is too much to transfer at one time per breast. I would recommend the ballpark of 200-300cc. This is due to survival rates. Fat transfer is a multi step process. Over the course of at least 2 transfer surgeries, you may be able to get 600cc per breast if you have enough at the donor sites, however in one surgery I would not recommend. Take of fat graft is only 60-80%. This drops if you transfer too much as the fat mound is too large and unable to establish a blood supply. So the middle of the mound will die and over time will involute as your body resorbs it. Resulting in much less take than if you stage it.

In summary, I think you would be an excellent candidate, however your expectations need to be adjusted to a lower volume with the understanding that not all fat will survive and you may need multiple fat transfers to get the volume you want with fat. If you want a quicker increase in volume, an implant is always an option and you can combine this with fat transfer.

Good luck!