Not a "Typical" Breast Surgery Request

i know most breast surgery is under general cuz its safer and the pt is comfortable.I also know that there's a limit of how much lidocaine(numbing solution) one person can have@ any one givin time. would a PS do a breast lift and aug just under the numbing solution(not IV sedation)? If PT perfers to have one breast done at a time under this local NS would any PS do it?i.e. do one breast lift and aug on day 1 than 3days later do the other just to keep it safe. I don't want general or IV sedation.

Doctor Answers (19)

Breast lift with augmentation under local anesthesia

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Thank you for your question. While not the norm, breast surgery can be done under local anesthetic with oral sedation.  However, I don't recommend having each breast done separately as your results may look different on each side.  Having the nerves numbed between your ribs, called "intercostal blocks" would be the key to success in doing it this way.  If you experienced significant discomfort and wanted to go to sleep, I recommend that you have in done in an accredited surgical suite so that if you needed to, anesthesia could be given in case you don't tolerate the surgery under local.  I must admit, many plastic surgeons would be reluctant to do a full lift with implants under local anesthesia alone.  Best of luck. I hope this helps.


Nashville Plastic Surgeon
5.0 out of 5 stars 33 reviews

Breast surgery request

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As a board certified plastic surgeon who has an accredited facility and routinely does all types of breast surgery (including reductions, lifts, and subpectoral augmentations) under local anesthesia and has done it for many years and thousands of cases, I think I can answer your question. The surgeon has to know how to do local anesthesia for the procedure. The IV sedation is so the patient doesn't have to be aware of it. 

Breast surgery is not done under general anesthesia because the patient is more comfortable. It's done that way because that's the way most plastic surgeon are trained and they don't feel comfortable doing major procedures under local anesthesia so they don't give the patient a choice. Local anesthetic techniques for major areas like the breasts require special training and experience as do the IV sedation techniques to accompany the local anesthesia. You can see the lack of experience in local anesthetic techniques in the comments about subpectoral augmentations. It's actually not difficult to put the chest wall to sleep with local anesthesia if your trained and experienced in it. 

Anesthesiologists or nurse anesthetists can do general anesthesia or IV sedation but the surgeon has to do the local anesthesia and it has to be effective. Inadequate anesthesia cannot be covered up with sedation and although an anesthesiologist can be prepared to switch from IV sedation to general anesthesia, a surgeon would have to work with local anesthesia and IV sedation alone and cannot switch to general anesthesia. If I were to do a breast augmentation under general anesthesia I would have to do this in an outpatient, hospital setting but I would still do the local anesthetic blocks for postoperative pain control. 

The amount of lidocaine (local anesthesia) required is not the issue with proper technique and experience. The amount required for both breasts at the same time is not a problem and offers several advantages over general anesthesia including safety, systemic or side effects, post operative pain control, less issues with nausea and vomiting, and cost. 

IV sedation is not anesthesia. It can be done by the surgeon or an RN under the direct supervision of the surgeon and is routinely done this way for other procedures under local anesthesia such as wisdom tooth extraction or non-local anesthesia procedures such as colonoscopies. Lesser procedures such as liposuction or blepharoplasty can be done with just oral sedation and local anesthesia but larger procedures require more control of the patient's sedation level and this means IV sedation with appropriate monitoring. Such sedation is for patient comfort in putting up with the local anesthesia injection and carrying out the procedure and most patients will say it was more comfortable and had less postoperative problems than general anesthesia. For example, a nose is fairly easy to put to sleep (anesthesia) with local anesthetic but the process of doing it and carrying out a rhinoplasty is not something the patient should need to be aware of and therefore IV sedation is utilized. 

There is absolutely no advantage to trying to operate on one breast on one day and the other breast on another day. 

Scott L. Replogle, MD
Denver Plastic Surgeon
4.0 out of 5 stars 1 review

Why?

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Theoretically, I could perform any surgery under local.  I could cut off someone's leg under local but why would I?  Anesthesia is for the patients comfort.  There are some procedures I will perform under local but there is no question that I would not perform a lift and augmentation under local. Additionally, I wouldn't do one side at a time either.

Jeffrey Hartog, MD
Orlando Plastic Surgeon
4.5 out of 5 stars 40 reviews

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Only local anesthesia for breast lift and augmentation.

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It is possible, in women with small ptotic breasts to do a breast lift under straight local.  A subglandular breast augmentation could also be done under straight local, but trying to place the implant under the muscle would be extremely difficult to give the patient an adequate level of comfort.  Doing one side first and then the other side at a later date is setting yourself up for asymmetry with unhappiness and the need for additional surgeries to fix it.  In today's world, general anesthesia is very safe and the surgeries you requested could be accomplished in about 2 hours.  It would make your experience so much better to have a general anesthesia and when you woke up it would all be done.

Jeffrey M. Darrow, MD
Boston Plastic Surgeon
5.0 out of 5 stars 32 reviews

Breast Augmentation and Lift under Local Anesthesia

+1

Foregoing general anesthesia and performing a Breast Augmentation and Lift under local Anesthesia Is "a long slide for a short base". 

Injecting large amounts of local anesthesia would 

- be associated with errors in determining breat size and location on the chest wall

- inability to control pain and be associated with movement during surgery

-  potentially dangerous to the patient 

and it has no reason except for patient misinformation and anxiety. While I am sure some surgeons may take some patients on, most surgeons would decline performing the procedure knowing the results would be inferior and potentially dangerous. 

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 60 reviews

Anesthesia for cosmetic surgery

+1

Doing what you want to do would be asking for trouble. The cost would be double and the results likely asymmetric as you could not easily make adjustments to the breast that was operated on first. Most doctors in the US will require general anesthesia especially if the implants are placed under the muscle. I have seen the procedures performed with the patient awake using a spinal block in other countries but I do not think any anesthesiologist in the US would be willing to do that. If a problem arose whereby the block went up the spine instead of down the case would be legally indefensible.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Not a "Typical" Breast Surgery Request

+1

You could probably find someone that would do a Breast Lift under local but it wont be easy...it sounds quite painful and most likely the surgeon will be pretty nervous and that's not always a good thing!!!

John J. Corey, MD
Phoenix Plastic Surgeon
4.5 out of 5 stars 17 reviews

Breast surgery under local

+1

this is an unusual request but not impossible.  i would consider taking oral medication for sedation.  staging the procedure is not practicalin terms of healing,, timing,  length of surgery..  the operations also take longer.

it would also be difffiult to place the implant under the muscle.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 17 reviews

Unsafe plans for breast lift and aug

+1

Thanks for your question -

I agree with the other surgeons.  There are many problems with your proposed plan.  First, it would be difficult to keep someone comfortable using local alone.  Discomfort in addition to being not fun for the patient could also lead to complications in terms of pocket creation or bleeding.

Secondly, planning to do one breast at a time is a recipe for asymmetry and patient unhappiness.

I hope this helps.

Steven H. Williams, MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 23 reviews

One question...why

+1

I don't know why you would want to have this done.  Unless you are looking to save money by not having an anesthesiologist present.  Anesthesia is very safe and unless you are concerned about losing control I would look closely at your reasons why you don't want any type of anesthesia.  Good luck if you find one.

Steven Schuster, MD
Boca Raton Plastic Surgeon
4.5 out of 5 stars 3 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.