Deowall Chattar-Cora, MD

Liposuction can be performed on a patient that is 280lbs.  However, understanding what the patient's expectations are is critical.  If the patient is trying to improve their ability to buy clothing,  or the patient has a particular area that they wish to address then it is not unreasonable to proceed with liposuction.

Performing a tummy tuck on a 280lbs has significant risks associated with it and most Board certified plastic surgeons would probably discourage it.  

It is not unusual to still have pain three weeks after surgery. There are several important things, the pain and swelling should be improving with time, there should not be any fevers or drainage from the wounds.  
The amount of swelling that each breast has will typically be different since a woman's breast are not identical (the fact that you have different size implants confirms this). Thus, the amount of tissue dissection will be different for each side.  
It is important that you contact your plastic surgeon since he/she was there during surgery and knows what occurred during surgery, and should know if your recuperation is progressing normally.  

The best way to choose an implant is to have an honest conversation with a board certified plastic surgeon.  During that consultation you should be able to tell your surgeon what your expectations are.  Your surgeon should then examine you and take measurements of your chest wall anatomy, and identify any differences between your breast.  After that your surgeon and you should discuss the benefits and drawbacks of each implant, incision and placement of the implant.   Based on all this information, you and your surgeon should be able to decide on an implant that is right for you.

The analogy I give some of my patients is to think shoe size, once we measure your foot  then we can choose a shoe based on your measurements. If we use a shoe that is either to big or too small it will look awkward.   

The choice of which implant to use is based on the patient's expectations, and anatomy.  It is important for the patient to have an idea of what they would ultimately "look" like. This should be clearly communicated to your surgeon.  

Your surgeon should do a thorough physical examination that will help identify any asymmetries, and potential areas that may need to be addressed.  During your consultation with your surgeon you should have had several measurements done.  These measurements help guide which implant size is appropriate one for each particular patient.  You should also have discussed the various types of implants: saline, silicone, and gummy bear.  

When looking at the photos that you posted, your right breast is larger and is lower than your left breast.  The image of the "look" that you want shows a woman with a breast lift.  If this is the "look" that you desire and are ok with the scars then you may need a mastopexy augmentation.  If you are not comfortable with the recommendations of your surgeon, you should get a second opinnion from a board certified plastic surgeon.  

when having liposuction, it is important for the patient and the surgeon to keep in mind the patient's overall expectations .  Thus having a candid conversation with your surgeon is important. Once the surgeon understands what the patient is hoping for, placement of the incisions required to achieve these goals  can be reviewed.  In the majority of patients these incisions regardless of where they are placed will heal nicely.  That being said, most plastic surgeons will try to place these scars in well hidden areas.  Unfortunately your contour irregularity does not appear to be a  result of where the incisions were placed.  

It is certainly early in your recuperation period and with some time this irregularity may diminish.  If it does not you should discuss this with your surgeon  to see what options are available to improve the outcome.