Breast Implant Surgery - General Anesthesia or Local Anesthesia?

I would like to have just local anesthesia for my breast implant surgery but it seems that most Dr.s only offer general....I am allergic to all narcotics and found that with my 3 C-sections, I was much happier being wide awake and aware for them. Can anyone please share with me the pros and cons and risks etc and why local is not offered as commonly? Thank you so much!

Doctor Answers 17

Breast augmentation surgery anesthesia

There are a few things to consider when thinking about breast augmentation surgery.  While you're considering your surgeon and evaluating if you like and trust him, you should take into mind his anesthesia prefernce  Presumably he has your best interest in mind.  If his prices are considerably lower than the majority of your other researched quotes, think about the anesthetic he is using.  On ocassion, some will use a local/regional anesthetic which means he will poke and infuse local anesthetic in the region of where the implant is being placed.  This means that he will be injecting multiple times in areas where you may or may not feel the injections and you will be somewhat awake, but not enough to feel them totally .. hopefully.  If you are lucky enough to not be able to feel them totally then in your very partially anesthesized state, you can theoretically help pick the size of your implants.  If you are not feeling anything because your "twilight" aneshtetic has you nearly generally anesthesized, then your airway is not protected by a general anesthetic and there can be trouble. 

For some reason that is unclear to me, this is a contentious point so know that it is my opinion but what is not contentious is that the majority of doctors that are doing this are not ABPS certified plastis surgeons.  Fact.

Dallas Plastic Surgeon
5.0 out of 5 stars 119 reviews

GA for augmentation

The reason most all do GA for augmentation is because it is safer and better in an acreditied facility with an MD anesthesiologist.

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

Breast Augmentation Under Local Anesthesia

Dear Mountain Girl At Heart,

The vast majority of plastic surgeons perform breast augmentation under general anesthesia because the procedure is more comfortable for both the patient and surgeon, particularly when placing implants below the muscle. This allows the surgery to be performed safely, efficiently, comfortably, and precisely.

I, too, prefer to perform breast augmentation under general anesthesia, but I will occasionally perform the procedure under local anesthesia with twilight sleep (ie. intravenous sedation) at patient request. The procedure can be done safely this way, but it generally takes longer to perform, and some discomfort may be experienced during the procedure. The cost of the procedure under both types of anesthesia is usually comparable at most surgery centers.

As an aside, I am aware of some doctors performing breast augmentation under local anesthesia with or without IV sedation for a very low cost. I would be careful of going to one of these doctors. Most are not Board Certified Plastic Surgeons, and most are not using accredited operating rooms.  I would only trust a doctor who is a Board Certified *Plastic Surgeon* working in an operating facility / surgery center that is accredited by AAAASF, AAAHC, or JCAHO. This is the only way to ensure that you're working with a surgeon who has the proper training, experience, and skills, and that the operating room is meeting the highest standards of patient safety. It's not worth risking your life to save a few dollars.

Warmest wishes,

Larry Fan, MD



Larry Fan, MD
San Francisco Plastic Surgeon
4.3 out of 5 stars 14 reviews

Breast surgery with local anesthesia

If you want to have your surgery with local anesthetic, it is commonly paired with sedation or "twighlight sleep".  This type of anesthesia is safe but not commonly used for breast augmentation.  The reason you could be awake for your c-sections is that you had an epidural or spinal in to numb your spinal cord from your waist down.  But you cannot use this type of numbing for your breasts because you would have to perform the epidural higher up which makes you unable to control your breathing, which is not safe.  Good luck!

Bivik Shah, MD
Columbus Plastic Surgeon
4.4 out of 5 stars 26 reviews

General anesthesia in breast augmentation

I always perform all my breast augmentations under general anesthesia because it gives me greater control and in my opinion is more comfortable for the patient. I place 99 % of my primary augmentations under the muscle and I cannot imagine that this can be done well with local anesthesia. I would have talk to my anesthesiologist about your allergiy to narcotics to see what can be done to alter your drug regime.   

Vishnu Rumalla, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 197 reviews

General anesthesia is better for breast augmentation.

It is better for the patient and also the surgeon when the patient is under general anesthesia.  If you are allergic, talk to the anestheologist and let them know your allergies.  This can be worked around.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Breast augmentation under local

There are several reasons why breast augmentation under local is a bad idea. The best results with breast augmentation come when the implant is put under the muscle. This is almost impossible to achieve under local because of the pain and discomfort. Therefore to be able to do this would cause incredible pain to the patient or a suboptimal result would have to be settled for. The amount of local required also starts to put the amount into a range which can be dangerous in order to achieve total comfort. It is possible to do a breast augmentation under local. It is not possible to do a good breast augmentation under local. There is a lot of activity trying to promote breast augmentation under local as a safe easy procedure. This is done by non-plastic surgeons who are trying to break into the breast augmentation business. Although they can technically perform a breast augmentation in this way, they are setting the patient up for increased risk of contracture bleeding and Infection.


Andrew Kaczynski, MD (retired)
Sacramento Plastic Surgeon
4.9 out of 5 stars 110 reviews

Breast augmentation and anesthesia

While it probably can be done under local, I think that most patients would be uncomfortable and I prefer general so that they can be more comfortable and I can do m y best work withotu worrying about the patient's comfort level.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast Augmentation Can Be Done Under Local Anesthesia But The Implant Must Be Above The Muscle

Most breast augmentations are done under general anesthesia for three compelling reasons; patient comfort, long-term implant benefits of being under the muscle, and a shortened operative time. (which also means lower cost) Breast augmentation can be done under local anesthesia but the implant must be placed above the muscle and the operation will take longer. (meaning the cost of the operating room will wipe out any cost savings from not having a general anesthetic) I have done a few breast augmentations this way because of patient's medical reasons and their adamant refusal of any IV or general anesthetic. It definitely can be done but the patient must have a really strong reason to do so and should use a silicone implant since it will be above the muscle.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Breast implant, anaesthesia

It will depend upon where the implant is positioned, above the muscle implant placement can be performed under local anaesthesia and mild sedation. If it is under the muscle then you may need deeper sedation. If procedure involves a technique to alter the muscles to position the inplant then a General anaesthesia is preferable.

Sanjay Parashar, MD
Dubai Plastic Surgeon
4.6 out of 5 stars 22 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.