Can breast augmentation subglandual be done under local anesthesia with sedation if I fear general anesthesia?
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The Plastic Surgery Channel Surgeon Answers: (5)
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Dr. Jacobs responded:
Absolutely, 100% yes!!
In fact, this is the ONLY way I have done this procedure, on an ambulatory basis in my fully accredited (by The Joint Commission) office surgical suite — for the past 25 years. It is safe, private and convenient. I have worked with the same MD anesthesiologist for the past 20 years. He provides superb "twilght sleep" anesthesia — no pain, no awareness, and a very quick recovery with no nausea, hangover, grogginess or sore throat. We have been able to do both sub-glandular and sub-muscular breast augmentation with this team approach. In fact, we use this same approach for virtually all of our breast reductions, breast uplifts, tubular breast reconstructions and breast symmetry operations.
Obviously, general anesthesia is an option and is used in certain circumstances. But for my routine cases, ambulatory, twilight sleep anesthesia has definitely been terrific for both me and my patients.
Elliot W. Jacobs, MD, FACS
New York City
Dr. Baxter responded:
There are really a couple of parts to your question. There are some who have promoted the idea of only local anesthesia for breast augmentation, which has a number of potential problems and is not generally recommended by plastic surgeons. Then there is intravenous sedation plus local, which is fairly common. The sedation is an important part of making it work. Then there is general anesthesia, which is quite a lot safer than people imagine. You should discuss all of the options with your plastic surgeon and decide which will be the most comfortable experience for you, keeping in mind that when the anesthesia is done by a qualified provider it should be safe whether it is IV sedation or general.
Dr. Rosenblatt responded:
If you fear general anesthesia, then the procedure can be done with sedation and local anesthesia. I have been doing this for years, when I first went into practice, anesthesiologists did not work outside of the hospital, so if we did this in our own operating room, we did the procedure under only local anesthesia with a little sedation. Now anesthesiologists love to work in our ambulatory ORs and can give our patients what they need and what they want. There is no problem doing this under sedation only.
Dr. Krieger responded:
While breast augmenation is most commonly pefromed under general anesthesia, it can be successfully performed under local anesthesia when combined with adequate levels of sedation. In my own practice, I routinely perform breast augmenation surgery under general anesthesia since this is both my preference and my patient's preference. If properly monitored, and in an appropriate clinical setting, however, breast augmentation can be performed with local anesthesia and conscious sedation. Since most patients undergoing breast augmentation are otherwise healthy, the risk of general anesthesia is minimal. Some facilities will offer to perform this procedure under local anesthesia with conscious sedation because of limitations of available aesthetic choices. Some facilities are not credentialed to provided general anesthesia requiring that the procedures be performed under local anesthesia. I perform my procedures in a fully credentialed facility that provides both local, regional, and general anesthetic options. This does not necessarily mean that general anesthesia is a better choice, only that it is another available choice preferable to some patients. Ultimately, I believe the decision f as to which anesthetic choice is most appropriate needs to be made by you in consultation with your surgeon. Good luck to you in the future.
Dr. Fournier responded:
Surgery can be done in San Jose, Costa Rica At Santa Rita Hospital, where local aneshtsia can be used with some sedation with pills and iv medicine given by a qualified anesthesiologist if necessary. Suregry is nomally ambulatory and silicon implant or saline can be put under the gland or under the Pectoralis major muscle. If more information is needed it can be sent by Email fourneir@racsa.co.cr.