Can I Have Breast Lift or Reduction Without Epinephrine?

I am 37. I am seriously considering a breast reduction or a lift or both. I have had a hx of tachycardia (controlled with low dose of beta blocker) and PVCs. I have had bad experiences with locals in the past (BP drops, BAD instant headache, heart racing). Can one have these surgeries without the use of a local? The only thing holding me back at this point is a fear of dying of severe complications. I am already terrified of GA...but now fear locals as well. Thank you for your time.

Doctor Answers 16

Breast Lifting Candidate?

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Thank you for the question.

Yes, breast lifting can be done without the use of epinephrine. In order to give you more peace of mind even I wish and by your internist/cardiologist  prior to surgery may be helpful.

Best wishes.

Having surgery under anesthesia

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The problems you described with local anesthesia can be easily controlled during your surgery.  If you are considering having surgery, perhaps you can ask for a consultation with the anesthetist that works with your plastic surgeon to alleviate your concerns.
Martin Jugenburg, MD

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 517 reviews

Yes, breast surgery can be done without local

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However it is much better if local anesthesia (even better with epinephrine) is used. There are many reasons why the use of local anesthesia is much better for you than not using it at all, many of the previous answers are missing the point ( and the scientific data), even that this surgery can be done with just IV sedation, i do believe it is much better for both the patient and the surgeon to do it under general anesthesia. The local is use mainly for pain control during and more important for after the surgery. There are several studies  (specially in the anesthesia literature) showing the advantage and the importance of using the anesthetic before starting the surgery, in this way you will also need less general anesthesia with hopefully less side effects from it.

My recommendation is for you to talk to your cardiologist and see his recommendations, also it will be good for you to see your anesthesiologist before the surgery and see his/her recommendations.

good luck

Victor M. Perez, MD, FACS
Kansas City Plastic Surgeon
5.0 out of 5 stars 30 reviews

Breast Reduction/Uplift & epinephrine

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General anesthesia is pretty safe these days , providing it is done in a controlled environment and superevised by a board certified anesthisiologist. As long as there is no history of Malignant Hyperthermia in your family you should not worry. Administration of epinephrine is not an essential part of any breast surgery . It only reduces blood loss . Breast surgeries do not need to be bloody operations. Go ahead with your surgery, make sure your plastic surgeon & their supporting team are aware that you do not want to have epinephrine.

Breast surgery without epinephrine

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The surgery may  be done without local with epinephrine.  But it does decrease bleeding.  Perhaps a cardiac clearance is in order to rule out any underlying pathology.  General anesthesia is very safe with the proper MD anesthesiologist.  Donald R. Nunn MD  Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 51 reviews

Can I Have Breast Lift or Reduction Without Epinephrine?

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Possible but would require cardiac clearance and in hospital surgery for possible bleeding issues. Best to see a boarded PS in your area. 

Concerns about general anesthesia and epinephrine

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In a reputable certified outpatient facility or hospital and using a qualified board certified anesthesiologist your risk for life threatening problems from general anesthesia are very low. It is understandable to have a fear of this, however.

With regard to epinephrine, it irrefutably does reduce the amount of bleeding from surgery and this has been documented by studies. I use it along with a local anesthetic in this type of case essentially always because it is effective in reducing bleeding and (the local) helps significantly reduce postoperative discomfort. Given your situation, there are two choices. The first is to use a very diluted concentration of epinephrine which will still be effective in helping with hemostasis (controlling bleeding) and may only have minimal effects on your heart rate and possibly PVC's. The other option would be to just use the local (of course, along with the general anesthesia) without the epinephrine which can definitely be done. There just will be more postoperative bruising.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 reviews

Breast lift and epinephrine

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Yes you may have a breast lift without epinephrine. Under general anesthesia you do not need epinephrine or local anesthetics. Some surgeons will use them anyway for bleeding and pain control but it is not mandatory. Discuss it with your surgeon.

No need for epi in breast lift/reduction

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You certainly don't need any local anesthesia for these surgeries.  I do all mine with a MD anesthesiologist under GA so no local is used at all.

Surgery without local anesthetic- is it necessary

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Almost all larger surgeries nowadays are performed with a combination of local and light general anesthetic.

The advantage of having an anesthesiologist there during the surgery is that they can administer medications that block the effects of the epinephrine.  The patient's body literally feels none of the effects of the local anesthesia.  The safety of having an accredited facility with a board certified anesthesiologist is quite high.  This does not mean that any patient can just have any surgical procedure using local anesthesia in an office, especially one without accreditation, safety measures, and anesthesia staff!

By far most patients who are "allergic" to local anesthesia are not truly allergic at all, just sensitive, and can have safe and uneventful surgeries if their anesthesiologist is prepared.

In fact we assume patients are sensitive to the effects of local anesthesia until proven otherwise, and routinely administer blocking medications.

Why have a surgery with considerable blood loss when the surgery could safely be performed with almost no blood loss?

Of course patients with cardiac conditions should have a workup by their cardiologist prior to their surgical procedure.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 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.