Tina Jenq, MD

I think you will do well with a breast lift without augmentation.  There is a good amount of breast tissue, and not putting in implants means that you don't have to worry about complications that can occur later associated with implants (capsular contracture, implant rupture, implant malposition).  In terms of you abdomen, it does not appear that you have much excess skin.  It really depends on your goals.  You may be able to get by with just liposuction.  However, if you want to be very tight (both skin and abdominal wall), it would require a tummy tuck.  The downside is a scar along the lower abdomen and potentially around the belly button.  

It is difficult to tell if the scar in your picture is hypertrophic or just wider. If the scar is more raised, firmer, and more tender compared to the surrounding skin, then you have a hypertrophic scar.  If the scar is wider but the texture is soft and the contour is flat, it is likely a widened, but regular scar.  Hypertrophic scars are not dangerous and can be left alone if they do not bother you.  Options for treatment if they do bother you include laser, steroid injection in the scar itself, and cutting out the scar and restitching it back again.  If you have questions, you should contact your plastic surgeon and they can help you figure out what is going on.  

Best of luck with your transition.  It appears that you have a sizable amount of breast tissue and skin that would require mastectomy and free nipple grafts.  In this situation, the scar is placed along the ideal inferior (bottom) border of the pectorals muscle, and then hockey sticked up along the sides of the chest wall.  This prevents developing a standing cone at the sides of the chest wall.  Sometimes it is addressing the sides of the chest that can be the more tricky.  

I think you should be honest and very clear about your goals. You should clarify whether you would like to look completely average (natural, a person down the street will not notice), lucky (naturally possible), or visibly lucky (what we see in magazines).  What your surgeon thinks would look good is not necessarily what you may feel comfortable with.  The size of the implant that works for you depends on your body frame, the width of your breast, and the amount of breast skin laxity you have.  Another factor is the size of the implant compared to the volume of breast tissue--too large of implant compared to breast tissue will be more palpable over time as it thins out your native breast and stretches out the skin.  Due to these factors, I always prefer to err on the side of implants that are smaller but you would still be happy.  

Seroma formation occurs due to an imbalance between production of fluid after a surgery and reabsorption.  We are hoping that the amount of fluid that is absorbed tips the balance so that this cavity of where the implant used to sit will decrease over time.  As the cavity decreases, the fluid production also drops.  Because of this dance of different factors, there is so no clear answer that works for every person.  Small enough fluid (less than 30 cc) will often get absorbed on its own.  Large enough cavity can continue to produce fluid and be a problem.  Some options include waiting, local compression to decompress the cavity, aspiration, or placement of a drain by interventional radiology. I hope you get better soon!