Twilight Sedation or General Sedation Safer for Breast Augmentation?

I have only met with one of the three surgeons but the first one performs the surgery under twilight sedation. I know I wouldn't feel anything and feel a but better not being under full, but is it safe to get a BA that way?

Doctor Answers 9

General anesthesia versus IV sedation

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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.

Twilight or general anesthesia for breast implant augmentation surgery

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In most cases, I prefer to use general anesthesia. I have done the procedure under local with IV sedation but the patients tend to experience more discomfort during the procedure. This is especially true if larger implants are placed under the muscle

Twilight anesthesia is a safe alternative for breast augmentation

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After over 20 years in practice and hundreds of augmentation procedures I can assure you that twilight sleep is an extremely safe choice for breast augmentation. If performed well in an accredited office facility the procedure should be pleasant and comfortable with little or any recollection of being 'in the room'. Office accreditation is an important commitment to safety so you should ask about it and be sure the facility and surgeon you select maintains high standards.

Best of luck,


Anesthesia for breast augmentation

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Both general and twilight sedation with local anesthesia are quite safe when performed in conjunction with a certified anesthesia provider in a certified facility. Many people doing breast augmentation, however, do not have privileges in a hospital to do that procedure and can not get a certified provider to work with them in a non-certified office facility. They will, therefore use twilight sedation with local anesthesia with one of their office personnel caring for you.

This is when safety becomes an issue. I personally use general anesthesia because it is easier on me and the patient and the recovery is faster. No matter what you choose, however, make sure the person providing the anesthesia is certified (nurse anesthetist or MD anesthesiologist) and that the facility is certified (by Joint Commission, AAAAMC, or equivalent).

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Twilight sedation for breast augmenation

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Both anesthetic techniques have their pros and cons- first and foremost- make sure you have a certified anesthesia provider caring for you.

I do a lot of my breast procedures under twilight anesthesia (IV sedation, MAC etc) and local anesthetic. Rib blocks in this setting are very helpful, and I believe are safe to do. The advantage of using an IV sedation technique is that the post-operative nausea issues are truly diminished. Patients wake up quickly after surgery and are less fatigued.

General anesthesia is also a great way to do a breast surgery- the muscles are relaxed and the operation can proceed quickly. However,  breast augmentation procedures don't take longer than an hour or so. Patients can have substantial problems with post-operative nausea after general anesthesia, despite the use of pre, intra and post-operative anti-nausea medication techniques.

Board certified anesthesiologist necessary for safe breast augmentation.

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Doing breast implants in New York City, we use light general anesthesia.  Sedation is OK too, if a board certified anesthesiologist is doing it in an accredited operating room.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Sedation or General Anesthesia for Augmentation

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I have performed breast augmentations for over 20 years using both local anesthesia with sedation and general anesthesia.  I feel either method is equally safe.  The trick is to have a very good anesthetist when using local/sedation which I think is a much more difficult technique than general anesthesia.  I would avoid a situation where the surgeon also delivers the anesthetic.

John Whitt, MD (retired)
Louisville Plastic Surgeon

General anesthesia is safer for a breast augmentation

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In order to numb your chest enough for a BA under twilight anesthesia, the surgeon typically performs nerve blocks by injecting local anesthesia between the ribs.  I know of a case in my region where this was done and the patient suffered two punctured lungs and arrested on the OR table.  Therefore, I would strongly suggest that you have a light general anesthetic by a physician anesthesiologist and have a safe and easy experience.

Twilight Extremely Safe

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With regards to anesthesia for a breast augmentation, either general or twilight/IV sedation will do the job.   Both are safe, but I prefer twilight/IV sedation for all my patients.  Some surgeons do not believe that you can go submuscular with twilight or sedation, which is why they use general anesthesia.  That is not the case at all - 90% of my patients are dual-plane ( partial submuscular), and have no problem with twilight anesthesia.  The recovery is alot easier, with no nausea, vomiting, etc.  There is no throat soreness, irritation, cough either.  In reality, the reason that some surgeons only use general anestheisa is because they do not know any other way to do it, so it is more comfortable to them to just do it that way.

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.