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Not a "Typical" Breast Surgery Request

asked 5 months ago by s.perez in San Antonio, TX
Latest answer by J. Jason Wendel, MD
Question viewed 255 times
Tags: anesthesia, numbing cream, sedation

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.

19 answers to Not a "Typical" Breast Surgery Request

Breast lift with augmentation under local anesthesia

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... more

J. Jason Wendel, MD
Nashville Plastic Surgeon

www.mc.vanderbilt.edu

Breast surgery request

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... more

Scott L. Replogle, MD
Denver Plastic Surgeon

Why?

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

Only local anesthesia for breast lift and augmentation.

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... more

Jeffrey M. Darrow, MD
Boston Plastic Surgeon

Breast Augmentation and Lift under Local Anesthesia

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... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Anesthesia for cosmetic surgery

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... more

Aaron Stone, MD
Los Angeles Plastic Surgeon

Not a "Typical" Breast Surgery Request

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

Breast surgery under local

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
Orange County Plastic Surgeon

Unsafe plans for breast lift and aug

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

www.trivalleyplasticsurgery.com

One question...why

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

Breast surgery under straight local

First, only treating one breast at a time may be difficult because swelling would ensue in the eraly post-op period and it could be difficult to "match them up." Second I think it would be too uncomfortable to do it jsut under local.

Steven Wallach, MD
Manhattan Plastic Surgeon

Breast aug under local unpleaseant in my opinion

For reasons of safety, comfort and symmetry, i would not recommend the procedure(s) you asked about be done under local anesthesia. saving a few dollars is not a good reason to have your operation done in this fashion.

Bruce K. Barach, MD
Schenectady Plastic Surgeon

drbarach.com

Breast Augmentation Under Local Anesthesia

I'm sure you can find someone who would consider your request. Of course it would basically double the cost because of two trips to OR, two sets of supplies, etc. It would not be likely anyone would do the placement under the muscle so you would have to put up with suboptimal appearance, and there would be no anestheiologist there to look after you in case of any medical reactions to the medications so your safety level goes down. Most patients have some discomfort during a local... more

Ronald V. DeMars, MD
Portland Plastic Surgeon

Subglandular breast augmentation under local only

It is possible to have a breast augmentation under a local only technique if you object to any kind of anesthesia or sedation. Subglandular breast augmentation can go very well, however sedation we believe can improve the experience. Best of luck, peterejohnsonmd.com

Peter E. Johnson, MD
Chicago Plastic Surgeon

www.peterejohnsonmd.com

Breast augmentation under local anesthesia

I would not perform a breast augmentation under local anesthesia; it cannot produce the necessary degree of anesthesia to perform this operation. Patient movement can have a deleterious effect. Similarly, this is not an operation that should be divided into two in terms of affecting the outcome. If you aren't comfortable with the appropriate sedation, as determined by an experienced plastic surgeon and the standards of our profession, then you are not a viable candidate for this elective... more

Robert L. Kraft, MD
New York Plastic Surgeon

Breast augmentation with local anesthetics

I would not recommend undergoing breast augmentation with straight local anesthetics. There is a limitation on how much local one can use on one setting. By separating breast augmentation into two separate days is not good for symmetry as well as delaying the recovery. I would recommend either IV sedation or general anesthesia for your comfort and safety.

Sugene Kim, MD
Houston Plastic Surgeon

Under a local

Doing them separate is a terrible plan with respect to achieving eveness or symmetry. If the implants are placed under the muscle( in my opinion-the best), numbing that area is very difficult. You should consider abandoning this idea.

Michael Hueneke, MD
Nashville Plastic Surgeon

Not typical breast surgery - not likely

It is never a good idea to ask a surgeon to modify what they have developed over years as their best practice pattern to suit your own issues. You would not tell a pilot how to fly a plane or a chef how to cook your food. There are many reasons your request is not reasonable and it might be best just to not have the surgery done unless you can come around to having the proper anesthesia.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Breast Augmentation/Mastopexy under Local Anesthesia?

Thank you for the question. I can only speak for myself; I would not offer a patient a breast augmentation/mastopexy under local anesthesia only. I would have two concerns about doing the procedure under local anesthesia only. First, I would be concerned about patient comfort. The vast majority of breast augmentation operations I do are sub muscular ( dual plane)- this involves some muscular dissection which would be very difficult to anesthetize adequately... more