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

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.

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.