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

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.

Intravenous sedation can certainly be used for breast augmentation.  The depth of sedation is something that can be fine tuned depending on your desires and what the surgeon needs to accomplish the surgery.  It also drove dis on your ability to have the surgery done under varying degrees of sedation.  Talk to your surgeon specifically about the level of sedation which will be used.

Hello,

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!

Hello and thank you for your question. I perform all of my breast augmentations under general anesthesia with a board-certified MD anesthesiologist present in the room at all times.  In my opinion, this is the safest route.  If you are set on IV sedation, ask your surgeon who is administering the anesthesia.  If it is not a board-certified MD anesthesiologist, I would be weary.  There is no substitute for safety.   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

Thank you for your question. Remember, it is best to be seen in person by a double-board-certified plastic surgeon for precise diagnosis and treatment.

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.

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.  

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 

I preform my breast augmentations under "general anesthesia" with my patient asleep.  Because most implants are place under the muscle, I feel the safest way to do the procedure is with my patient asleep.  Should you become too anxious or have too much discomfort in the middle of the surgery, your anesthesiologist would have to "change gears" and sedate you more heavily, that could lead to loss of your airway, etc.  Awake procedures are possible but should only be done if you surgeon is very very comfortable with it along with your anesthesiologist.  I would in principal refer any patient wanting sometimes I am not comfortable with to go an see another surgeon.  Your safety is first and foremost, you greatest priority.  There are few medical indications to have an augmentation completely awake.

Thank you for your question. If you wish to be "awake through the procedure", intravenous sedation will need to be titrated precisely (there is no specific "level" of anesthesia required).   This type of anesthesia is not something I would recommend or offer to you. I  recommend that you have the  procedure performed under general anesthesia supervised by a Board Certified Anesthesiologist.  I believe that this type of anesthesia provides for a comfortable/safe/immobile environment to perform the  procedure.  ***Be careful that you do not short change yourself when it comes to selection of plastic surgeon, safety considerations, and ultimately outcome of the procedure with your priorities to be available for  "intakes" soon. 

I hope this, and the attacked link, helps.