"Awake" breast augmentation vs general anesthesia. What are the pros and cons?

I'd like to hear PS's share their opinion on the Awake approach to breast surgery (especially doctors in Dallas/Houston areas). Pros, cons, and their comfort level with it, and why a patient would be or not be a good candidate for it. Does it costs more or less?

Doctor Answers 16

Awake anesthesia for breast augmentation

There are plastic surgeons that use IV sedation with local anesthesia for breast augmentation and get wonderful results. I personally prefer general anesthesia for patient comfort and muscle relaxation (this is helpful when using submuscular technique). If using sub glandular technique, IV sedation with local anesthesia is more reasonable from my perspective. Usually the cost for the procedure is usually very similar.

A word of caution: some doctors perform breast augmentation with IV sedation in their office operating room because they have no other choice. In other words, the local hospitals will not allow them to do this surgery because they are not plastic surgeons and/or they have not had the appropriate training. Please inquire if the doctor is a plastic surgeon, if he has privileges at the local hospital to perform plastic surgery, and if the operating room is certified/accredited. 

Thanks for the question and best of luck!

Be sure to check the credentials

As you could see from the previous comments, it is very important you check the credentials of the physician you are consulting with. There are few board certified plastic surgeons that will offer you this "awake anesthesia option", however if you tell them that you will prefer to be completely under they will have privileges in a surgery center. If the surgeon tells you that he/she only perform the procedure in their office, that is a red flag and you should pay special attention, specially if the surgeon calls him/herself a "cosmetic " surgeon.
My recomendation is that you see only surgeons member of the American Society for aesthetic plastic surgery, this will assure you the surgeon is board certified and his practice is dedicated to aesthetic surgery.
Good Luck

Victor M. Perez, MD, FACS
Kansas City Plastic Surgeon
5.0 out of 5 stars 23 reviews

Ideal Anesthesia for a Breast Augmentation

Your question is a very good one, since the matter that cares after this kind of surgery is Pain. In our personal experience we prefer to have an Epidural anesthesia by an experienced Anesthesiologist and it will give a pain protection for a couple of hours after the procedure, so the antalgic that we prescribe will be doing the higher effect just after this period, so it will avoid discomfort in the patient making It a magical experience.

Luis Lopez Tallaj, MD
Dominican Republic Plastic Surgeon
5.0 out of 5 stars 2 reviews

"Awake" breast augmentation

I want my patients to be comfortable and relaxed during the procedure. Under straight local without and sedation in my opinion may not be appropriate in the majority of patients.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Check the doctors credentials

Awake breast augmentation is a technique that is often used by non-plastic surgeons. There are board certified plastic surgeons that use this technique, but it would be very important to make sure that the person performing the procedure is not a family medicine doctor, a dermatologist, or an OB-GYN. Board certified plastic surgeons receive extensive training in breast augmentation and can provide you with the best care available. General anesthesia is an excellent way to have a breast augmentation. The surgery can be less than 30 minutes, with one hour of anesthesia time. Administered by a board certified anesthesiologist, it is a safe and comfortable way to have the surgery.

Awake breast aug pros and cons

I have been performing awake breast augmentation for over four years. I am one of a few Board Certified Plastic Surgeons by the American Board of Plastic Surgery that perform the procedure in my Medicare certified surgery center.  The pros for me are you avoid the risks of anesthesia, avoid loss of control, avoid the fear of not waking up, avoid nausea/vomiting.

The cons are there is some mild discomfort but very tolerable and you will feel a lot of pulling and tugging.  The other cons other than myself, is most are not board certified plastic surgeons and do not perform the procedure in a certified facility. By not having the proper certification and by not performing it in a Medicare certified surgery center they do not have privileges to perform the procedure in a hospital. This creates a higher risk of problems such as infection control etc.  So it is important to find a surgeon who has the right credentials and performs it in the right facility.

Best Regards,
Dr Gartner

Awake breast augmentation

An awake breast augmentation can not be expertly performed.  The patient comfort level will be inadequate during an awake augmentation to proceed with the necessary techniques for a successful breast augmentation. IV sedation or general asthenic is usually required.

Awake breast augmentation

I see no advantage and several disadvantages to awake breast augmentation.  I think that patient's are safest and the results the best when the patient is being cared for by an anesthesiologist during surgery,  I think that breast augmention is best done with muscle relaxation which requires general anesthesia.  General anesthesia is extraordinalily safe in the correct setting.

Beware many doctors who offer "awake" brast augmentation are not plastic surgeons and are doing such surgery in an unsafe setting.  Fatalities have occured in the hands of unqualified doctors performing breast augmentation in unsafe settings.  Check the American Society of Plastic Surgeons website to make sure your surgeon is a board certified plastic surgeon.

Awake breast augmentation can be very difficult for the patient

Attempting to do breast augmentation with only local anesthesia is extremely difficult.  The difficulty is with the amount of pain and discomfort that the patient experiences.  Intravenous sedation can help but in my experience I always perform breast augmentation under general anesthesia.

Beware Awake Surgery

If by Awake surgery you mean that your anesthesia will be completely local with a couple of pills to take the edge off the pain then you should be wary of who is doing the surgery.  As previous answers have noted, breast augmentation can be and is often done with local anesthesia while the patient has intravenous sedation and is in a "twilight " state.  I don't know about Texas, but here in California, any surgery that is done under intravenous sedation or general anesthesia must be done in an accredited facility.  One of the requirements for accreditation is that the surgeon be board certified and have hospital privileges to do the surgery he is doing in his own OR.  On the other hand anyone with an MD after their name may call themselves a plastic or cosmetic surgeon and do anything they want under local anesthesia with no intravenous sedation, with the patient awake, in their office. That is how some poorly or untrained doctors get around the regulation. That's right, even a radiologist or psychiatrist could take a weekend course on breast augmentation and start doing the procedure in their office on Monday as long as it is under local anesthetic only.  The sad thing is that two of the breast implant manufacturers will sell them breast implants no questions asked.  You should first be more concerned about the training and skills possessed by your surgeon than by the type of anesthesia used and how much it costs.  You should find an experienced plastic surgeon who is certified by the American Board of Plastic Surgery and does all his procedures in an accredited facility.  The course that we took to be certified by ABPS was more than a few weekends long.  Upon completing medical school it took us 2-3 years of training in plastic surgery residency AFTER 3-7 years of training in general surgery or a surgical subspecialty. 

Lars Enevoldsen, MD
Modesto Plastic Surgeon
4.7 out of 5 stars 22 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.