Gavin M. Dry, MD

From the photos, it looks like you should be able to have a low scar. The reason to have a vertical scar in your situation would be if the surgeon felt that you would benefit from having skin removed in the center of your abdomen with a so-called Fleurs-de-Lis approach. All the best to you. 

In short to answer your question, you could achieve a significantly larger size by placing an implant but not with fat grafting. Fat grafting can be an excellent way to slightly increase the fullness of a breast but at best it can only increase the size by 1 cup. In order to achieve the best aesthetic outcome and meet your goal of increasing the breast size, it seems that it would be optimal to lift the breast and place in an implant. The specific end cup size is very difficult to predict as all bra companies go by a different sizing criteria to come up with the cup size. 

I would certainly recommend that you discuss your activity level with your surgeon. Every surgeon has a different post-operative protocol for activity level. Feeling very tight after only 2 weeks is normal. Please bring this up with your surgeon as they will be the best to answer this question for your specific situation.

In general, the greatest risk for DVT comes from longer surgeries with general anesthesia. In your situation where you are just having local anesthesia and a short procedure then the risk should be minimal. Getting up and walking during the flight and staying well hydrated would be best. I would recommend discussing this with your surgeon as well. The flight itself should have no effect on the overall outcome of the surgery or interfere with the healing process.

Congratulations on the weight loss. It would be optimal to have a consultation with a Plastic Surgeon experienced in procedures after weight loss. With most people that have lost as much weight that you have it is necessary to perform a circumferential procedure (such as a belt lipectomy or body lift) to be able to remove enough tissue to make the remaining skin tight.  Sometimes, simply revising the FDL will not allow the surgeon to remove enough loose skin. 

What you should do is really dependent on what you want to go through and what you are looking for as an end result. Any non invasive treatment will mean slightly less down time but will not produce significant changes. A lower face and neck lift will help tighten the neck skin, remove the jowls and define the jaw line. From the photos, it seems that if you wanted to create the best result for the longest period of time then a surgical lower face and neck lift would be optimal. 

Your saddlebag region looks to be easily treated with liposuction and you should be able to have a great result. For your situation there probably will not be a difference with the type of liposuction used (traditional, ultrasonic, laser etc). I would recommend seeing an experienced Plastic Surgeon and following their advise regarding the type of liposuction that they are most comfortable with. 

It is certainly optimal to determine the appropriate size of the implant with a thorough discussion with the surgeon. Trying on implants in the office helps to determine a size range that may give you the results you are looking for but there are other variables that need to be discussed and evaluated in person (such as skin laxity, sagging to the breast, tissue thickness etc). Placing in the same size implant into 2 different people will produce 2 very different sizes and shapes. So please do not worry too much what others may say online regarding implant size.

Fat grafting to the breast can increase the size by about one cup. So, in your situation you may realistically be able to go from a 32a to a 32b with one procedure. If you wanted to go larger then it may require additional fat grafting procedures at a later date. The number 32 is a measurement of circumference of your chest. Fat grafting to the breast will not increase you from a 32 to a 35.

It is very normal for you to have swelling and for the breasts to feel firm at this point. The implants will usually sit a little higher right now and will settle with time. As the implants are in the sub-glandular position the breasts will continue to look more "natural" as time goes on.