Can I have breast augmentation while on 81mg of asprin?

In the ideal world, you should be off of all anticoagulants for 7 days prep. That being said, with meticulous hemostasis, drain placement, and prep cardiology clearance I suspect that you will be fine.

There are several areas to comment on your situation: (1) being on aspirin should not be a problem with good technique i.e. no blunt dissection (2) drains will not prevent a hematoma and (3) fitness for surgery. I would ask your cardiologist about risk stratification and let your plastic surgeon know about ANY cardiac history.

ideally you should be off all anticoagulants. Plavix isn't an option but low dose aspirin with a drain and meticulous hemostasis may be possible. Ask your ps what their comfort level is

I definitely agree with stopping Plavix before surgery. Being on 81 mg of aspirin or baby aspirin may induce additional bruising, however, with meticulous hemostasis or control of bleeding in the operating room you would likely be able to proceed with breast augmentation. This is a question best answered by your plastic surgeon who may have had experience with patients on aspirin.

I personally would not operate on a patient who is on aspirin under the circumstances you present. This is an elective surgery and you would be at higher risk for hematoma. Drains are not the issue. Even if a patient wants to assume risks, it is the responsibility of the plastic surgeon and the anesthesiologist to determine whether they are comfortable operating given the patient's medical condition.