I am considering Breast Augmentation and I've noticed that some surgeons use twilight anesthesia while others use general anesthesia. What are the benefits of one type over the other in Breast Augmentation surgery?
Anesthesia for Breast Augmentation
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Doctor Answers 18
It is better to have more MDs looking out for you
When I am doing surgery, I like to concentrate on the surgery, and the result that I am trying to achieve. I do not like to be distracted by anything else (such as my patient's vital functions--breathing, circulation--and comfort with pain control). It is not that I could not manage those issues, but to do so would require that I split my concentration from the main reason that brought us to the operating room. As such, I like to use a board certified anesthesiologist to assure my patient's comfort, and maintain all vital functions. This makes my procedures a bit more expensive, as we have to pay for the anesthesiologist, but I think this is in everyones best interest and worth it.
If the patient wants to use twilight anesthesia, I have no problem with that, so long as it is provided by a board certified anesthesiologist.
Sedation Anesthesia for Breast Augmentation
Since I own my own surgicenter, I have a complete control over who my anesthesiologist is. I use exclusively MD anesthesiologists. Incredibly enough, it is hard to find an MD anesthesiologist who is proficient at Sedation anesthesia.
I myself had to learn how to use local anesthetics in an efficient and comprehensive way so as to minimize the amount of sedation given. A good team proficient in the technique will give you:
1)-Great analgesia during surgery- you will not feel anything
2) Amnesia- I have yet, in a year and a half of using exclusively sedation for breast augs, have a patient tell me they remembered anything. As a matter of fact, it is EASIER for a patient to get "light" during general anesthesia (while paralyzed with a tube down their throat) and remember stuff, than it is for a sedated patient with an anesthesiologist competent in sedation techniques. The reason is that during sedation the anesthesiologist will be better able to see and monitor the patient getting light than during general anesthesia.
3)Better analgesia AFTER surgery- Because the nerves were anesthetized BEFORE surgical injury, and because of the greater reliance on longer acting local anesthetics, the patient has less pain after surgery. There is plenty of experimental evidence backing this up.
Sedation gets a bad rep because many MD anesthesiologists learn mostly General anesthesia during their residency and don't feel comfortable with sedation. Sedation is harder and requires more concentration to find the "sweet spot". An MD anesthesiologist not proficient with sedation techniques takes the patient on a roller coaster ride where sometimes the patient is too light, then he over reacts and overmedicates and you find yourself struggling to keep the patient's airway open. An MD anesthesiologist proficient in Sedation techniques gives the patient a smooth ride ant the airway is never in question.
I did Breast Aug with General anesthesia for many years, and the best testimonials come from patients who have had both types performed. There is no question they prefer sedation. I will never go back to general anesthesia. In longer cases General Anesthesia has higher risks of pulmonary embolus and pulmonary complications, and in all cases, patients feel much worse after surgery. If it was my daughter, or wife, (or even me!), sedation is the way to go.
There are advantages/ and disadvantages of both
I was trained to do breast augmentation using exclusively general anesthesia. For six years of residency and first year out this was my routine. I had heard of colleagues doing breast augmentation under sedation and my initial thought was, why?
Having spent five years since that time doing breast augmentations with deep sedation and excellent local anesthesia I have found a number of advantages and sedation is now my preferred method.
A little background regarding how I prefer to do this is necessary.
The level of sedation that I use is moderate to deep sedation with propofol, deeper than what I would consider "twilight anesthesia". I use a board certified anesthesiologists, which I feel is very important for patient safety. After an initial bolus of propofol, the breasts are completely anesthetized with a large volume of diluted local anesthetic. At this point the patient could be awakened without much pain. However, my anesthesiologist keeps the patient at light to moderate sedation. Any areas without adequate local anesthesia would be identified by patients response and additional local anesthesia can be used. Long lasting local anesthetic for postoperative pain control is placed in the implant pockets through catheters after the procedure is complete. There is little to no pain, remembered or forgotten during the procedure.
In my opinion, the disadvantages of this approach are:
- Additional time and effort at the beginning of the procedure for placement of local anesthesia in exactly the correct place
- Combining other large procedures at the time of breast augmentation is limited by the amount of lidocaine that can be safely used
- The anesthesiologist has to be comfortable with titrating the correct level of sedation. However, in 5 years and over 300 augmentations we have never had to intubate or even bag-mask a single patient.
In my opinion, advantages include:
- Comfort - the local anesthesia HAS to be excellent. Generally the patients have little to no pain immediately afterward when the pain is generally the worst. (I don't want to be misleading here, that night when the blocks wear off it HURTS!!!)
- Less "hangover" from anesthesia
- Significantly less nausea (less anesthetic)
- Quick recovery - patients stay in recovery as long as they/ we need them to but this is generally only 15 - 30 minutes. Patients are wide awake quickly and walk from the OR to recovery immediately afterward.
- Cost - In office operating suite.
There are certainly advantages to both. Your board certified plastic surgeon will discuss which he/ she is most comfortable with and which is most appropriate for you at the time of your consultation.
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Anesthesia for breast augmentation is a matter of opinion
I prefer a short general for a number of reasons:
(1) I use only MD anesthesiologists in a certified surgery center. They are very good at keeping the doses small. Nausea is a very infrequent problem.
(2) The patients are the most comfortable and it is safe.
Doing the surgery under sedation is possible, but I prefer "under the muscle" implant placement which is harder under less than a general.
Anesthesia for Breast Augmentation
Thanks for the question Anesthesia can be performed in a number of ways and in combinations. Most plastic surgeons will perform the procedure under general anesthesia. This allows for maximum protection of your airway and provides maximum comfort of the patient allowing your surgeon to shape things perfectly. In our San Francisco office we typically do this procedure with general anesthesia but augment it with local anesthesia including pain pumps when appropriate. This allows our patients to safely have the procedure performed with the maximum comfort during and after the operation. I hope this helps.
General anesthesia versus IV sedation for breast augmentation
Anesthesia for Breast Augmentation
Anesthesia and Breast Surgery
I would suggest that you be very careful with your surgeon selection and experience. Safety should be the first priority in every surgery. I hope this helps.
Anesthesia Options For Breast Augmentation
General anesthesia better for breast augmentation.
I always use general anesthesia for breast augmentation. You should really be asleep for the procedre for your comfort and also so the surgeon can work more efficiently. You are also sat up to make sure the implants are even. Being asleep is better.
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