Alternative to General Anesthesia for Breast Augmentation?

I want breast augmentation but do not want general anesthesia? Is it possible to have the surgery with conscious sedation and local anesthesia instead?

Doctor Answers 25

General anesthesia perhaps "easier," but NOT "better" or "safer"

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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.

Breast augmentation with sedation and local anesthesia - video

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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.

York Jay Yates, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 189 reviews

Anesthesia and Breast Augmentation

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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.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Yes, but...why?

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Let me be up front with my bias, I think it is not a good idea.

Having said that, when I was a plastic surgery resident, we did a lot of BAMs with valium, and a breast block. This involved injecting local anesthesia between the gland and muscle while the patient was sedated. The implant was then inserted above the muscle.

Since 1993 I have been in private practice, and I have switched to placing the implants under the muscle because I believe that it produces the superior long term result. I have not been convinced that local anesthesia can adequately work so that the procedure can be done SAFELY. aesthetically, and comfortably for the patient. One big concern in this setting is that patients often de-saturate their blood oxygen and this is not safe.

Breast augmentation does not require a general anesthetic (but I wouldn't recommend that for most patients).

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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.

Breast augmentation

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In general, I perform breast augmentation either using general of conscious sedation as you mentioned. It is discusse with the patient by both me and the board certified anesthesiologist that works in my office.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

You could have alternative anesthesia, but WHY

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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.

You could opt for anesthesia alternative, but should you?

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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.

Michael S. Beckenstein, MD
Birmingham Plastic Surgeon
4.9 out of 5 stars 21 reviews

There are options, but I wouldn't say they're better.

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Clearcourt: I have many years experience in practice and I prefer light general anesthesia for breast augmentation, provided by a board certified MD anesthesiologist. Of course, that includes complementaty local anesthesia.

In earlier years I have done the procedure under conscious sedation plus local. It is a reasonable alternative. Some of the surgeons I trained with use that method primarily. Other surgeon's have proposed regional nerve or epidural blocks, but I am not aware of anyone using those methods.

Conscious sedation often means that there will not be an MD anesthesiologist present. If your goal is safety, then you should inquire about that wherever you decide to have your procedure.

I suspect that if you make inquires, you will be able to find a surgeon near you that uses conscious sedation. I suggest you make quality surgery your primary goal when picking someone as your surgeon.

Sutton Graham II, MD
Greenville Plastic Surgeon

Anesthesia with breast augmentation

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Almost any surgery can be performed under IV sedation. The comfort level for the patient is not quite as good as with light general anesthetics, but it can easily be done.

It is best and safest to have an MD anesthesiologist administer the anesthesia rather than the doctor himself with significant procedures. This is to ensure the maximal safety and the maximal patient comfort. It is also best to have surgery in a safe setting such as a fully accredited surgical center or a hospital. that way safety equipment and the necessary properly trained personnel are on hand, for every single case.

The problems occur not with routine cases, but with complications. What, for example, would the surgeon do if a pneumothorax (deflation of a lung) occurred during surgery and there was no anesthesiologist there? Or an unexpected allergic reaction?

All questions to consider and address with your board certified plastic surgeon.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 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.