Tummy tuck with local anesthesia and iv sedation?

Question

I am interested in having a tummy tuck with NO muscle repair , I do not want general anesthesia , is it safe to have it done with local and iv sedation , or is there still a high risk I'd lidocaine toxicity , thank you !

Eric Swanson, MD · Answer

I always do abdominoplasties under IV sedation with local anesthesia. There are many advantages. There is no need for paralysis, intubation, gas, or mechanical ventilation. You breathe spontaneously during surgery. The abdomen is infused while you are asleep with a dilute solution that contains bupivacaine. The amount absorbed is very small and there is a wide safety margin (I've measured levels in my own patients). It provides longer pain relief than lidocaine and toxicity has not been reported when it is used in this manner. It is unnecessary to paralyze patients, and you are not even having a muscle repair. From a blood clot (DVT) perspective, IV anesthesia is better because the calf muscle pump is preserved. I frequently discuss this alternative type of anesthesia at meetings and have written articles on it. I call it SAFE anesthesia (Spontaneous breathing, Avoid gas, Face up, Extremities mobile). You can learn more by reading about it on my website. I'm attaching a link.

Boonchai Taweerattanasil, MD · Answer

Hi, this is possible. However please make sure a well experience plastic surgeon and a board certified anesthesiologist to carry out the procedure either under local anesthesia or IV sedation,

Goodluck!

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. The most important priority for me is safety in the operating room.  In my practice the safest setting for surgery is general anesthesia administered by a board-certified MD anesthesiologist.  If you are an appropriate candidate, a tummy tuck can be done through a low and short
incision, all completely below the bikini line. 
The belly button can be designed to look natural and have no scars on
the exterior.   
Make sure you specifically look at before and after pictures of
real patients who have had this surgery performed by your surgeon and evaluate
their results.  The most important aspect is to find a surgeon you are
comfortable with. I recommend that you seek consultation with a qualified
board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  You can perform a tummy tuck under IV sedation and local anesthesia but your safety should be paramount and without a full series of photographs it is difficult to determine if you are a good candidate.  Be sure to see an ASPS board certified plastic surgeon in consultation to discuss your treatment options.

Andrew Gear, MD · Answer

Anesthesia safety is an area of debate amongst surgeons, and there is no right answer. We are creatures of habit often without the hard data to back up our habits. Yes, a TT can be done under local or tumescent anesthesia (minus muscle repair although some practitioners are now numbing the fascia with local too). It can be done under MAC anesthesia (monitored IV sedation + local anesthesia). It can be done under general anesthesia with paralysis and gas. I have done all three. The nexus of the debate over TTs and anesthesia involves thromboembolic events (DVT>>PE). GA relaxes and dilates the venous system, and in conjunction increased intra-abdominal pressure, can, in certain patients, lend itself to clot formation (so the theory goes). Some surgeons argue that MAC anesthesia is "safer" due to the absence of venous dilation, paralysis, etc. I am uncertain of the veracity of this. Propofol (a primary drug used in MAC) also causes venodilation.

If muscle repair is in order, then either MAC or GA is required. Most post-pregnancy TT patients require muscle repair and to not do so is a disservice to your body IMO.

The question is why are you afraid of GA? I tell patients driving your car around is more dangerous from a statistical standpoint. When executed by a competent practitioner, its uber safe. Good luck.

If muscle repair is in order, then either MAC or GA is required.  Most post-pregnancy TT patients require muscle repair and to not do so is a disservice to your body IMO.

The question is why are you afraid of GA?  I tell patients driving your car around is more dangerous from a statistical standpoint.  When executed by a competent practitioner, its uber safe.  Good luck.

Rick Rosen, MD · Answer

I would not recommend it, as the fatty layer needs to be elevated off the underlying muscle layer, and that is very difficult to numb up while doing the elevation. I would recommend a general anesthesia with a board certified Anesthesiologist is safer and better for you.

Eric A. Weiss, MD, FACS · Answer

The single most important factor is to be safe. I believe general anesthesia with a BS anesthesiologist is much safer in many situations than local and IV sedation. There are too many questions left unanswered for your specific case. How big are you? how much skin needs to be removed? Is the local and sedation administered by the surgeon,or is there an anesthesiologist present? why are you adverse to general anesthesia? Can you have surgery with LMA or general IV anesthesia. I would be hesitant to do such a case under local as lidocaine toxicity is a real concern and can be lethal complication of trying to do too much with out general anesthesia.Eric Weiss MD

Tom J. Pousti, MD · Answer

Thank you for your question. Although a variety of types of anesthesia can be utilized, I perform tummy tuck surgery under general anesthesia only (Board Certified Anesthesiologist). The abdominoplasty is an extensive procedure and I would recommend general anesthesia so that you are as comfortable/safe/immobile as possible during the procedure.Generally speaking, the tummy tuck procedure typically involves plication of the abdominal wall muscle that have spread during pregnancy or weight gain/loss. It is the very rare patient who after pregnancies and/or weight gain/loss does not benefit from some degree of abdominal wall muscle re approximation.

IN MY OPINION, omitting this part of the procedure for the vast majority of patients who present for consultation will possibly or likely leave them with continued abdominal wall laxity and, in my opinion, a less than optimal result. Make your decisions carefully…

Best wishes.

IN MY OPINION, omitting this part of the procedure for the vast majority of patients who present for consultation will possibly or likely leave them with continued abdominal wall laxity and, in my opinion, a less than optimal result. Make your decisions carefully…

Best wishes.

Karol A. Gutowski, MD, FACS · Answer

Yes, this is possible, but you should seek out an experienced surgeon for this. It is better to have a skilled anesthesiologist who does IV anesthesia also.

Ronald V. DeMars, MD (Retired) · Answer

It is possible but you will find few experienced surgeons that will tell you it is a good idea. And even if you do it that way you would be foolish not to have a board certified anesthesiologist at your side for titration of meds and emergency airway management. Most experienced surgeons will tell you modern general anesthesiology can be safer than local with sedation.

Tummy tuck with local anesthesia and iv sedation?

Answers (10)

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