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Risks of Twilight Sedation for Breast Lift and Augmentation?

I'm a healthy 27 year old. I've been to a consultation with a local Dr. and I'm considering a Breast lift/Breast implants. However, I want to eliminate as many risks as possible. Is twilight "safer" than general? What are the risks of twilight sedation during this procedure?

And, can you please recommend someone in Mississippi, TN, or TX who does this procedure and is a Board Certified Plastic Surgeon? I'm having a difficult time finding a qualified Surgeon who uses twilight sedation. Thank you in advance for your help!

Doctor Answers 13

Breast Lifting and Type of Anesthesia?

Thank you for the question.
There is absolutely no evidence that “twilight sedation” is safer or provides for a better experience/outcome for patients undergoing plastic surgical procedures. In my practice I prefer the use of general anesthesia provided by board-certified plastic surgeon  who knows my routine well.
In regards to finding a plastic surgeon in your area, I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons.

Then, I would suggest you visit a few surgeons whose practices  concentrate on aesthetic surgery. Ask  to see lots of examples of their work and preferably speak/see patients who have had similar procedures done.

You will find,  while doing your due diligence,  that there are many different “specialties” who will offer their services to you;  again, I strongly recommend you concentrate on surgeons certified by the American Board of Plastic Surgery.  
I hope this helps.

Twilight vs. General

I recommend that you focus on the anesthesia provider rather than the type of anesthesia. I insist on a board certified M.D. anesthesiologist to provide my patients' anesthesia care. Most of my patients undergo breast lift/implant surgery under LMA (laryngeal mask airway) anesthesia, but depending on their history, anatomy, etc., the anesthesiologist may recommend endotracheal intubation or a lighter form of anesthesia called MAC (monitored anesthesia care).

Breast lift with implants using twilight sedation

There are many ways to perform a breast lift with implants. Patients that receive twilight sedation will not be aware of their surroundings and will not be completely asleep. It is important to ensure that your board-certified plastic surgeon has a great deal of experience performing this procedure with this type of anesthesia. The anesthesiologist must be very vigilant to make sure that you are comfortable but that you do not experience pain. The portion of the procedure that will create the most discomfort is the elevation of the muscle and the placement of the implant. If you choose to proceed with this level of anesthesia, be sure that the facility you are using has board-certified anesthesiologists who are ready to administer general anesthesia is necessary.

Pat Pazmino, MD
Miami Plastic Surgeon
4.5 out of 5 stars 67 reviews

Board Certified Anesthesiologist very important for breast lift with breast implants.


Both twilight anesthesia and general anesthesia are very safe and equally safe for breast lift with breast implants.  The important question is WHO is giving you the anesthesia.  Also make sure you are done in an ACCREDITED operating room.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Type of Anesthesia

Twilight anesthesia may not be safer than general anesthesia especially if you are going to be under for a while, as you will be for a breast augmentation and breast lift. So I would be very carefull in regards to this. As long as you are healthy and have no medical problems that you may be ok for general anesthesia.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 59 reviews

BAM: Do you really want your plastic surgeon to be your anesthesiologist?

There are many issues here:
1) Some people believe twiligtht is safer.
This is not necessarily the case.
2) Some believe it is less expensive
Only if your surgeon is the anesthesiologist and do you want him or her to worry about the heart rate, oxygenation, and blood pressure while giving you anesthesia or do you want him/her to focus on your surgery
3) Is your implant under or over the muscle.
If under the muscle, it may be difficult to adequately anesthetise the area especially while inflating the implant and stretching the muscle. This may involve injecting close to the ribs.
If the implant is to be placed over the muscle, it is possible to deliver local anesthetic under IV sedations
4) In any instance make sure you have a certified anesthesiologist delvier your anesthesia
The risks of twilight essentially include nearly all the same risks as a general anesthetic.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 56 reviews

Go with a general anesthesia by a physician anesthesiologist

A twilight sedation for a breast augmentation is usually supplemented by nerve blocks with local anesthesia. I am aware of a situation where these were done and punctured the lungs causing serious complications. Under a light general by a physician anesthesiologist, these nerve injections are not necessary and this risk is eliminated.

Be sure there's an anesthesiologist or nurse anesthetist giving anesthesia...

I'm also a proponent of general anesthesia...not because it can't be done under sedation, its just much more patient dependent and the chance of inadaquate anesthesia is higher than it would be with general.
The point I wanted to add was to be sure its not THE SURGEON giving the anesthesia. Unfortunately, some docs recommend sedation to cut corners. They give the anesthesia AND do the surgery. Obviously, you can't keep track of both at the same time and, even with a nurse helping you, its not the safe way to go. Insist on a licensed, board certified anesthesia provider.

Robert Frank, MD
Munster Plastic Surgeon
5.0 out of 5 stars 17 reviews

Breast Augmentation and Twilight Anesthesia

Your fears are understandable, but with a light general anesthetic the risks should not be much more than a twilight anesthetic. The general anesthetic is also cleared very rapidly after you "wake up". Also, in certain states you cannot have twilight anesthesia as an office operating room procedure, it must be done in a certified ambulatory surgical center. or facility. You want the best possible outcome for your surgery, certainly with reasonable risks, and a surgeon can do a better job in developing the pocket and dealing with any unforeseen problems such as annoying bleeding or areas in which the nerve blocks have not fully achieved the anestheisa desired.

Theodore Katz, MD, FACS
Philadelphia Plastic Surgeon
5.0 out of 5 stars 7 reviews

Twilight sedation for Breast Surgery

Local Anesthesia with Sedation, or Twilight anesthesia, is a very effective and safe way to perform Breast Enhancement procedures. In fact, 95% of my patients undergoing breast augmentation with implants choose twilight sedation and respond afterward that the experience was not that discomforting. For most of my patients it comes down to the fear of "going under" anesthesia, recovery time, nausea effects afterward, and cost. The patient is given an IV sedative to relax them, then I perform local anesthetic nerve blocks under the ribs (where the nerves arise) and the breast tissue itself to achieve anesthesia of the chest and breasts. The nurse can deliver more medication for pain and sedation as necessary during the procedure while still monitoring vital signs. Implants can be placed above or below the muscle, and simple breast lifts can be performed as well. The only patients I feel need a general anesthetic are those with prior breast implants who need a removal/replacement or formal breast reduction/lift. Local anesthesia with sedation is safe, easily performed, less costly and well tolerated for straight forward breast enhancement procedures.

Sanjay K. Sharma, MD
Austin Plastic Surgeon

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.