Alternative to General Anesthesia for Breast Augmentation?

Thank you for your question.

I read with great interest the answers of several of my colleagues, many of whom clearly prefer general anesthesia over sedation:


• You could have alternative anesthesia, but WHY
• You could opt for anesthesia alternative, but should you?
• Yes, but why?
• It is possible, but not 100% safe
• General Anesthesia is usually a better choice
• Yes, but it is safer to have general anesthesia


While I agree that general anesthesia is a completely reasonable option, I completely disagree with the statements that "it's not 100% safe," "yes, but it is safer to have general," etc. The implication here that sedation anesthesia for breast augmentation cannot be achieved with at least equal safety as general anesthesia is FALSE.

When performing breast augmentation as a sole procedure, I elect to use "heavy" sedation in collaboration with an Anesthesiologist or Nurse Anesthetist. For my patients, I believe the benefits of sedation in combination with long-acting local anesthesia are many:


•Better postoperative pain control
•Less total amount of anesthesia required
•Lack of a general anesthesia "hangover" or fatigue that can last for days
•Lower risk of blood clot
•Equally as safe, if not safer, than general anesthesia


Safety in aesthetic plastic surgery is paramount. Every patient should receive a detailed preoperative workup and risk-assessment in preparation for surgery.

I have seen breast augmentation patients that have had surgery under general anesthesia in tears in the recovery room from pain. Under general anesthesia, there is no feedback to the surgeon during surgery about how well their local anesthesia block, if any, has worked. With my approach, I have become very experienced with the with getting an excellent local anesthesia block such that by far the most common sensation felt by patient in the recovery room is "pressure," not pain.

Bottom line: I prefer sedation anesthesia for breast augmentation.

Hope this helps.

Thank you for your question.  Most breast augmentation should be performed under general anesthesia. General anesthesia is extremely safe when performed by a board-certified anesthesiologist in an accredited operating room facility.

Yes, it is possible to use local anasthesya in this surgery. And there may be benefits in both approaches, if performed by high skilled and very experienced surgeon. But at the same time there are many points which made us consider general anesthesya more safe and more comfortable for both - the patient and the surgeon.We used to combine local and general anesthesia when perform our Breast augmetation. You will be fully asleep and completely unaware of anything; during your sleep, your condition will be controlled by various sophisticated monitors to ensure that you are fully comfortable.You will not feel any pain, while your surgeon will have enough time to perform the surgery.The anesthesia begins with the insertion of an intravenous line by the anesthetist, through which you will be given medication to relax you and to put you to sleep, also you we will get liquid and any necessary medication through it. The general anesthesia is maintained by gases that you will inhale through a tube. We inject local anesthetic into the breast area, so that when you wake up from the general anesthesia your breasts feel frozen and you have minimal discomfort.Blocking nerves around the ribs and numbing the muscle itself also helps to minimize the amount of general anesthetic, and when the surgery is over and the gas is swithed off, you will start to wake up over the next 60-100 seconds.Our patientsthat have had surgery under general anesthesia are never "in tears" from pain in the recovery room, they don't feel sick, and are quite comfortable.

Thank you for your question. Both types of anesthesia can provide a safe and comfortable platform for breast augmentation surgery. It is more important that you feel comfortable with your surgeon and the surgical plan as this is ultimately what you will be remembering after the procedure.

It’s possible to perform breast augmentation utilizing
either IV sedation or general anesthesia.Each approach has advantages and disadvantages.Both approaches have advocates. It’s important
that the anesthesia be administered by a board certified anesthesiologist
regardless of the type of anesthesia utilized.This is an important point because IV sedation is occasionally
administered without an anesthesiologist as a cost cutting maneuver.When this happens, your surgeon is also your
anesthesiologist.I
generally prefer general anesthesia for a variety of reasons.I typically place implants beneath the muscle
and feel that general anesthesia makes the experience more comfortable for my
patients.With newer anesthesia agents,
patients tend to recover quickly with less nausea and few side effects. It’s
important to discuss these issues with your plastic surgeon before proceeding
with surgery.It’s important that both
of you are comfortable with the choice of anesthetic.In some cases, it might also be helpful to
meet with the anesthesiologist before proceeding.

Breast augmentation is most commonly performed under general anesthesia.  That is the way that most of us were trained and comfortable with.

Although I do not fault any plastic surgeon who prefers general anesthetic for breast augmentation, let me provide an alternative view.

Although I initially did ALL of my breast augmentations under general anesthesia, I now prefer to do ALL of my breast augmentations under local anesthesia with deep sedation. 

Disadvantages of local + sedation


More difficult for the plastic surgeon initially.  Excellent, precise, local anesthetic must be placed by the surgeon.  (This eventually becomes an advantage as the procedure is basically bloodless with excellent local anesthetic)

Risk of injury to underlying structures and lung injury with poor technique (I have personally never seen this but skill with local anesthetic techniques is obviously necessary)

Fear of "being awake" for the patient.  The level of sedation is easy to control for a skilled anesthesiologist.  The level of sedation I prefer is similar to a nap.  NO pain or wiggling (no stimulation as it is numb), NO talking, NO memory.  The patient generally walks from the OR to recovery but doesn't remember how they got there.


Advantages of local + sedation


Less nausea - I would consider this THE biggest advantage

Easier recovery without anesthetic "hangover"

Less pain after surgery, fewer pain medications used - assuming more precise local anesthetic than would be done under general anesthesia 

Less risk - of course this one is controversial.  There are risks with either but there are some risks specific to general anesthesia such as malignant hyperthermia and some inhalational medication reactions that are eliminated

Piece of mind - most of my patients are pleasantly surprised that the procedure can be done without a general anesthetic.  For the ones who are initially taken back by the idea, a little explaining of what to expect goes a long way.  


Of course it is not for every plastic surgeon.  I can tell you that I am happy with the technique and would never consider going backwards.  I have NEVER had a single patient wish that we had chosen a general anesthetic for breast augmentation.

For a video demonstration see below.  This video is 3 years old and there are a few technical things that I do differently today but the sedation and local anesthesia have changed little.

I used to do all my augmentations with twilight anesthesia.  However, because general anesthesia is actually easier on the patient and makes the operating time less, I do nearly every patient under general.  But the short answer to your question is yes, the procedure can be done with local and sedation.

The gold standard is general anesthesia for breast augmentation. For some reason, people are scared of general anesthesia. There have been several advances in general anesthesia and in most cases, it is the safest way to go. It seems that people somehow think general anesthesia is still practiced the way it was 50 years ago. Well, it is not. It is possible to have breast augmentation under local anesthesia with sedation, but then you are moving around making the surgery more difficult and distracting the surgeon who should have 100% concentration on the patient.

There are many alternatives but if you decide on "unders", it is my advice to proceed with general anesthesia. I have used several methods but prefer the patient to be completely at rest while releasing the muscle. This can be painful and it is difficult to achieve satisfactory pain control under local anesthesia. If you are proceeding with "overs", I believe you can achieve satisfactory control with IV concious sedation.

Breast augmentation can be performed with other types of anesthesia that you mentioned. I will never utilize them for my patients as I believe true general anesthesia is the best for patient and surgeon. Make sure your surgeon has a lot of experience with this type AND a certified anesthesiologist or anesthetist with alot of experience as well will do this for you.