Bottoming Out Revision Under Local Anesthesia? (photo)

Hello! I am getting a revision in January because my left breast is sitting lower than my right. My doctor said it will be an easy fix under Local and he will use dissolvable sutures. Is this repair really done under local? What is the chance of this to re-occur again? Recovery? I have a 2 y/o & a 9 month old & he said I will need help with them for a few days. The fix will be free which is great but I am worried about being awake thru this and being in pain. Thanks!

Doctor Answers 15

Anesthesia for Breast Implant Revision

Dear proud_mommy:

Anesthesia for breast implant operations vary from surgeon to surgeon.

As you can see from the responses here, most surgeons prefer to  use general anesthesia because you will be completely comfortable.

However, other surgeons successfully use local anesthesia with or without intravenous sedation (twilight sleep) with only minor discomfort (eg. being at the dentist).

I hope this helps.

Warmest wishes,
Larry Fan, MD

San Francisco Plastic Surgeon
4.3 out of 5 stars 14 reviews

Revision of Bottomed Out Implants


The local anesthesia could be a good choice in specific cases.

Unfortunately, without knowing the full details of you planned surgery it is difficult to provide you with a solid stand as to whether you should go for a local anesthesia or not.

The main benefit provided by the local anesthesia is saving money otherwise a patient has to pay when an anesthesiologist and a surgical staff in a booked OR are involved.

I recommend that you consult with your surgeon expressing your concerns; if the surgery is complex then a general anesthesia is required.

I hope this helps.

Thank you for your inquiry and the best of luck to you.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 197 reviews

Implant revision under local anesthetic?

I think the operation I do for bottoming out would be very hard to do under local without the patient having considerable discomfort. I usually use strong, permanent sutures that I place deeply into the layer just above the ribs and I don't think I could get good anesthesia with just local.  Or I use a piece of Strattice to form an internal bra and that operation is very, very complex and again, I wouldn't want to try it under local.

Now if you had the opposite problem and the implant needed to come down, doing that is usually quite easily done with local. 

I'm sure your surgeon is trying to save you money by not having an anesthesiologist but honestly, it is so important to get these revisions right and not compromise what is done because of patient discomfort.   I think the money spent on an anesthesiologist is money well spent.

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 73 reviews

Breast revision under local

I agree that the procedure can be done under local in most cases.  Your surgeon is likely trying to,save you the cost of an anesthesiologist which You would probably have to pay for.  The greatest risk with the operation is recurrence of bottoming out; it's not always that easy to correct and for it to hold up over time.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Bottomed out under local? Not for me

To fix a bottomed out implant involves using many sutures into the tissues near the ribs and this hurts.  I would not advise it under local, maybe revisit this with your doctor.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Bottoming Out Revision Under Local Anesthesia?

For me to revision a "bottoming out" would be very difficult under local anesthesia. Maybe you should discuss this more. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Revision breast surgery under local anesthesia

It appears that your left implant has bottomed out. The repair is actually quite involved in order to achieve long term success. Usually this requires repairing and tightening the lower portion of the capsule to elevate and reset the lower breast fold. In addition the upper capsule may need to be opened up to allow the breast implant to be positioned slightly higher on the chest wall. If the capsule is very thin or weak, reenforcement may be necessary for the repair to hold up. Whether all of this can be performed under local anesthesia is up to the surgeon's preference. The critical point is where the revision takes place. It's much safer to have this performed in a fully accredited outpatient surgical center even if it's done under local anesthesia. The goal is to do the proper repair and it's quite challenging to do all of the above under local anesthesia. It can be done but I am not so sure it should be done under local anesthesia.

Best Wishes,

Stewart Wang, MD FACS, Wang Plastic Surgery

Stewart Wang, MD, FACS
Los Angeles Plastic Surgeon
4.6 out of 5 stars 28 reviews

Revision Breast Implant Surgery Under Local Anesthesia


Which anesthesia you choose is less important than some other aspects of primary and revision breast implant surgery.  Regardless of the anesthesia, the surgery should be performed in the same environment that you (hopefully) had for your initial surgery:  a fully accredited, ambulatory surgery center or hospital based surgery center where lighting, equipment/instruments, assistants, and (most importantly) sterility is optimized.  These types of facilities are not free, even if the surgeon is a co-owner.

As for the anesthesia, I only perform that surgery under general anesthesia. Capsulorrhaphy is not easy, even when performed on a regular basis, and requires the patient's muscles to be fully relaxed, something that is not possible when you are awake.

I would have a discussion with your surgeon and clarify that he is going to take you to the same place where you had your original surgery, and not in his office, even if it means that you will have to pay for the facility; it will be worth every penny.  I would also recommend you discuss anesthetic options again with your doctor too.  In an optimized environment under general anesthesia, your results should be very good to excellent, and the chance for recurrence minimal.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 90 reviews

Can bottoming out be repaired under local anesthesia?

I would caution against this because the implant should be removed to work inside the pocket to repair the capsule. I would discuss exactly what your plastic surgeon is proposing. I wish you well.

Dr. Edwards

Michael C. Edwards, MD, FACS
Las Vegas Plastic Surgeon
5.0 out of 5 stars 35 reviews

Bottoming Out Revision of Breast Augmentation Under Local Anesthesia? (photo)

In my experience, this is not an "easy" fix.  Correction should allow the left implant to be repositioned upward, which may require opening the top portion of the "capsule" around the implant.  Also, if the crease at the bottom of your breasts is raised, it must be a durable repair, and nicely curved to match the right side.  After suture placement, usually performed in the supine or "laying down" position, the result must be evaluated sitting or standing up.  Placement of these "capsulorrhaphy" sutures should NOT injure the implant, so usually, when accomplishing this type of "Ryan" reconstruction of a higher inframammary crease, I remove the implant, and replace it following the repair.  Removal and replacement of the implant is not normally done under local anesthesia, as far as I know.  

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 47 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.