Local Anesthesia for Submuscular Breast Augmentation Possible?

I'm a 22 year old girl. I am considering Breast augmentation. My question is, can I have Breast Implants, either silicone or saline submuscular under local anesthesia?

And if I consider Saline implants, will it be noticeable and look and feel natural? Thank you for your help.

Doctor Answers 18

Breast augmentation more difficult under local anesthesia

Usually, local anesthetic (with IV sedation) breast enlargements are done over the muscle since it is a lot easier to numb the breast and difficult to numb the muscle which is vascular and down deep.

There will be struggles on your part, and your doctors, to numb, and relax the muscle just with shots of local anesthetic. Tumescent local anesthesia helps, but tumescent anestheisa doesn't diffuse well into the muscle.

Nerve blocks around the ribs help a lot, but the lung can be punctured with this technique. Even numbing the breast with a lot of needle injections risks a lung puncture and has some dangers. Muscle itself is hard to numb with local anesthetic injection.

General anesthesia has risks, but most plastic surgeons prefer the extra time and comfort to sculpt your breast to fit your new implants.

I think it is best to allow your surgeon freedom to do the best artistic work while you are asleep. This avoids pain from local anesthesia injections that can be insufficient or that wear off too quickly.

Good luck.

Marin Plastic Surgeon
5.0 out of 5 stars 2 reviews

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Local anesthesia for breast augmentation is possible

You will not have local anesthesia, but probably have local anesthesia with IV sedation. It is possible to do it, but buyer beware. A lot of doctors who are not plastic surgeons are offering breast augmentation by local anesthesia not because it is the best choice for their patients, but because that is the only way they can do it . They may not have hospital privileges to do the procedure, they may not have the equipment necessary to offer you more options, and they may be skimping out on an anesthesiologist.

Recently I completely revised an augmentation that had been done by a gynecologist who "does" cosmetic surgery under local anesthesia in his office. The patient needed a lift but had not been offered that at the first procedure. She also had completely inadequate placement of her implants and they rode too high. So she had a second surgery by me with new implants and a lift in order to achieve her goals.

But, she had had the original procedure under local. You decide what makes more sense.

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 16 reviews

No to breast implants under local anesthesia

It will be helpful first to distinguish between the various options for anesthesia. When we say local anesthesia, that typically means no other medications such as sedatives are used. At the other end is general anesthesia, where the patient is completely unconscious. In between is a very common technique which uses local anesthesia plus intravenous sedation, so that you are given medications through an IV. I would not suggest that you try to have implant surgery done under local only, but it can be a very good experience with the IV.

Silicone implants almost always feel more natural than saline.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 30 reviews

Possible but painful

Anything is possible. But the best results and your comfort is our responsiblity as plastic surgeons. I do many breast augmentation surgeries. All are done with an anesthesiologist putting our patients asleep and making them comfortable.

Go to a Board Certified Plastic Surgeon for the best results. You will be glad you did.

Good Luck!

Andrew Cohen, M.D.

Andrew T. Cohen, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 13 reviews

Yes, it is possible

While most surgeons do not perform this, I do this for about 50% of my patients. Patients experience a shorter recovery that less painful. In addition, you'll be able to see your results sooner. However, it is absolutely necessary that you find a plastic surgeon who has experience performing this technique. 

Local Anesthesia for Submuscular Breast Augmentation Possible?

Thank you for the question.

Every surgeon will have his/her preference. I prefer the use of general anesthesia provided by a board-certified anesthesiologist.  I have found that the  use of general anesthesia is safe, comfortable for the patient, and predictably maintains a patient in a good position (without movement)  during the procedure. I think the latter is important as we are trying to achieve as much symmetry is possible.

Most important will be your choice of surgeon. Physicians who are board certified in plastic surgery hold a certification with the American Board of Plastic Surgery (ABPS). This certification proves that the surgeon has graduated from an accredited medical school, has completed a residency of at least five years, has three years of experience in general surgery, is actively practicing plastic surgery for at least two years, and has passed mandatory comprehensive and written examinations. These surgeons are referred to as diplomats of the ABPS and have fulfilled the aforementioned requirements. I would suggest that you select your plastic surgery carefully; NOT based mainly on the type of anesthesia that he/she will perform their procedure under. Then, communicate your goals carefully as well. During this consultation process, your other questions in regards to type of implants, incisions, size concerns… will be addressed. Best wishes. 

Local anesthesia for breast augment

Most surgeons use a general anesthesia for breast implants especially sub muscular. The surgery is very safe and lasts less than an hour, so anesthesia complications are very rare. I have seen many attempts using local anesthesia and it usually is not that comfortable for the patient. The silicone implants will give a better look and feel but saline can work as well if you have enough breast tissue. 

Breast augmentation under local

It is certainly possible to perform breast augmentation under local anesthesia.  However, I think it is safer to perform this surgery under general anesthesia, you have better control of implant placement and control of bleeding.  Beware of doctors who only offer surgery under local anesthesia, you are better off looking for a board certified plastic surgeon.

Dennis Dass, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 65 reviews

For a natural look use silicone implants in a subfascial plane

It is certainly possible but its just safer more pleasant and more reasonable to sedate the patient if going under the muscle.  However if you are after a natural look I would avoid under the muscle and look into subfascial placement.  In my opinion, using the subfascial plane is really the only way to get the most natural appearing tear-drop breasts.  This is why I developed the COLD-SUBFASCIAL technique.  Also avoid Saline as they dont look or feel antural and tend to age faster.  Using silicone with fascial support will deliver the most beautiful, longest lasting augmentation,.


All the best,


Rian A. Maerkcs M.D.

Rian A. Maercks, MD
Miami Plastic Surgeon
5.0 out of 5 stars 39 reviews

Breast augmentation can be performed under local anesthesia, either with intravenous

sedation or with tumescent anesthesia (similar to liposuction).  Particularly if the implants are placed in the subglandular position (above the muscle), you might do very well without general anesthesia.  As regards your question about saline implants, iif you have them placed above the muscle then you can have a problem with rippling in the implants that can be visible through the skin.  If my patient is determined to use saline rather than silicone, that I would recommend placing the implants under the muscle, rather than above the muscle.

Michael H. Rosenberg, MD
White Plains Plastic Surgeon
5.0 out of 5 stars 2 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.