Rosiane A. Roeder, MD, MPH

Hi. Breast asymmetry is normal. All women are asymmetrical to some degree. You may have a component of tuberous breast, but looking at other angles and a clinical exam can further elucidate that.

A breast augmentation with nipple reduction is a good option for you. Breast implants and fat grafting are both good options, however it may take 2-3 procedures to augment with fat graft depending on how  large you want to me, how well the graft takes and donor site limitations.

I recommend you talk to a board certified plastic surgeon in your area about these options. They can help you explore the risks and benefits of the procedures, guide towards the option that suits you better, and most importantly answer questions about breast implants that may help clarify any questions you may have about their safety to calm your fears. 

Exparel is a long acting local anesthetic. It should last 24-72 hours. Although it may not completely eliminate all of the pain, it definitely helps reduce the need for narcotic medication after surgery.

The pain experienced with breast augmentation when the implant is placed under the muscle is mostly due to the muscle stretch. Most describe the pain most as a feeling of an elephant sitting on their chest. 

Although every patient experiences pain differently, most of my patients take only Tylenol and Ibuprofen, with only a few needing narcotics for 1-3 days after surgery. I routinely use a local anesthetic like Exparel on the muscle.

You've had two kids, so as with child birth, any surgery is not completely painless process. But, you've had to keep the eye on the prize: a new you.

Good luck. You will do great.

Hi. Wound healing complications, although not unusual can be distressing. At this point, the wound has healed and will be the way it is forever, unless revised. Please go see your surgeon. This can be easily addressed in the office and I expect you'll have an excellent result.

Thank you for your question.

I think the key point is why you are on Eliquis to begin with. Your candidacy for surgery may be more dependent of that, then simply the blood thinner itself.

Breast augmentation is a purely elective surgery and only a direct examination of your medical history can determine your candidacy.

I would tend to side with the 4 colleagues who have seen you in person. If your medical history changes and it no longer requires you to be on Eliquis or if you can be off or bridged during the operative time, you can be re-evaluated and your candidacy re-examined.