Can 500cc, above muscle, silicone implants be removed in the the office with local anesthetic or do I have to go under general?

Removing silicone implants under local anesthesia is appropriate only in the simplest case of pure removal. When placed through an inframmary incision, the implant never really touches the breast tissue; it slides underneath it, so this approach has the least impact on the gland itself. Removing the implants and the capsules through the inframmary incision should not cause issues with breastfeeding. Leaving a capsule behind is preferred if it is thin and pliable. If there are calcific components, or silicone granulomatous material, or if the capsule is deforming the breast tissue, then removal of the capsule may be warranted. The removal of breast implants as a stand alone procedure can be performed under local anesthesia.

At times implants can be removed under local anesthesia. This would be limited to straightforward implant removal, leaving the capsules behind. Not all surgeons offer this method, so you will want to research a surgeon near you that does.

Dear new to surgery,
it is hard to tell for sure without an examination. Generally speaking, it is possible to remove implants under local anesthesia. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

If you are breastfeeding, the removal may need to wait, or you can pump and dump. For that size, removal will be easier with your asleep, but it could be done in the office under local anesthesia. Your incision may need to be widened under local anesthesia. Removal may or may not improve your breastfeeding.

Removal of a 500 cc implant may leave you with enough loose skin that you would prefer to have a lift and under those circumstances, general anesthesia would be better choice EXCEPT that you are breast feeding so now is not the correct time for surgery in my opinion.