Breast Augmentation - which level of iv sedation + local anesthesia is needed to be awake through the procedure?

Dear Doctors, I've found a couple of Board Certified Plastic Surgeons through RealSelf, who'd perform surgery while being awake, which is a must for me. I have a couple of intakes next week. I found different opinions when it comes down to iv sedation. I wonder which level or degree of iv sedation is needed to be awake through the whole surgery, and being able to communicate like the patient in the picture. Thank you in advance.

Doctor Answers 14

Breast augmentation and TIVA

Performing a breast augmentation while you continue to protect your own airway and don't require a breathing tube is called TIVA - or Total IntraVenous Anesthesia.  It is an advanced anesthesia which started on the West Coast.   Generally, patients are given some form of narcotic as well as Diprivan.   During the case, your surgeon may use local anesthesia at the incision as well as Exparel - a long acting local anesthetic - around the implant pocket.   Hope that this helps.  

Durham Plastic Surgeon
5.0 out of 5 stars 8 reviews

BA with IV sedation and local anesthesia

While it is difficult to find a surgeon to perform a breast augmentation under sedation with local anesthesia, it is still possible. You will want to find someone who is very experienced with the technique, is board certified, and works in a certified facility to ensure that you have the safest setting possible. 

You should consider why you want to be awake during the procedure. For large implants, it can be quite uncomfortable to place the implants using just local anesthesia.

Good luck!

Breast Augmentation under Local Anaesthesia

Dear p.h.h.,

It's difficult for me to recommend any procedure which I would not perform on close friends or family members. Breast Augmentation under local anaesthesia is one of those procedures. Please realize that the published literature in plastic surgery shows that there are many more complications with this procedure when it is done under local anaesthesia. These include bleeding, over sedation and respiratory arrest, pneumothorax ( a collapsed lung) and the need for revisional surgery. Oftentimes, the only reason to do this under local anesthesia is simply to cut costs. In other circumstances, the surgery center where the operation is being performed is not licensed or credentialed to do general anaesthesia. Please be certain that your surgeon is a board certified PLASTIC SURGEON and a member of ASAPS or ASPS, and that the facility is duly accredited.

Do your home work. Good Luck!

Alfonso Oliva, MD, FACS
Spokane Plastic Surgeon
5.0 out of 5 stars 35 reviews

Breast Augmentation - which level of iv sedation + local anesthesia is needed to be awake through the procedure

That is an unusual question, I must say, but moving forward as to answer your question, the more local anesthetic and the less IV sedation, the more awake you will be

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 25 reviews

Breast augmentation

I am not sure why you would want to do it under local. IV sedation can be given at all different levels to make you comfortable for the procedure.

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

Breast Augmentation - which level of iv sedation + local anesthesia is needed to be awake through the procedure?

It's unclear why being awake is a "must" for you so it's difficult to respond to your specific circumstances.  However, in general I'd warn you that you may end up sleeping through painful parts of the procedure, or not recalling but still suffering through possible discomfort with the use of amnesics. Think carefully since surgery under local definitely compromises your surgeon's ability to give you the best result IMHO.  I'd also strongly encourage you that an anesthetist be present to safely administer any iv sedation.  Good luck either way and best wishes,  

Jon A Perlman MD FACS 

Certified, American Board of Plastic Surgery 

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016 

Beverly Hills, Ca

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 29 reviews

Awake Surgery


Is it because you want to see what size you're getting? Or are you afraid of general anesthesia? This is not definitely going to happen, regardless of the surgeon you pick.  Based on your current issues with your breasts and what will need to be done intra-operatively; what will you do if the doctor needs to do something that hurts and he can't numb it with local anesthetic? Did you know that's a possibility?  I think that you're better off finding a ABPS certified/ASAPS member surgeon that specializes in revision surgery. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

Breast augmentation

Like many others have said I would not recommend this procedure under a local anesthetic. In Australia where this is commonly performed there have been many cases of lidocaine overdose and a few cases of death. 

Best wishes 

Theodore Nyame, MD
Charlotte Physician
5.0 out of 5 stars 28 reviews

Augmentation Awake

There is no benefit to a patient being awake under sedation as they will be sleepy and unlikely to remember the procedure if they are to be comfortable. In this state the patient's input into size or appearance is not useful as they are not in their right mind. Additionally, if a patient were awake enough to play any meaningful role in size selection, they would likely be very uncomfortable for this invasive procedure. General anesthesia is very safe and by far the most common approach for this procedure. Be weary of surgeons offering shortcuts like this for any advertised reason as the likely motivation is improving the surgeon's bottom line or avoiding the fact that they are not qualified to operate in appropriately credentialed facilities. Limit your search to Board Certified Plastic and Reconstructive Surgeons and to maximize your chances of avoiding unforeseen complications.

Joseph Parks, MD
Jacksonville Plastic Surgeon

Breast Augmentation - which level of iv sedation + local anesthesia is needed to be awake through the procedure?

I'm afraid I couldn't answer this as we have not done augmentations awake in over 15 years. Prior to that we did the procedure awake because it was safer than a general.That has not been the case for a long time. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 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.