What determines if gynecomastia surgery can be done by a local with IV sedation or general anesthetic?

Smaller gynecomastia procedures are performed under local anesthesia and oral sedation.  This is a very well tolerated procedure that takes about an hour or less to complete.  The patient goes home the same day and begins the recovery period.
The larger gynecomastia correction procedure which involves greater tissue removal as well as skin removal is usually performed under general anesthesia.  This male reduction procedure takes less than 2 hours to complete, even in the most complicated of cases. The patient goes home the same day

Dear AnyGivenSunday,
this is a topic you want to discuss with your plastic surgeon and anesthesiologist. Generally speaking, type of surgery, length of surgery, previous experience with general or local anesthesia are important topics. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

I'm so sorry you had a bad experience with anesthesia in the past. In my practice, like many others, there are multiple options available for anesthesia.  Your board-certified anesesiologist will discuss options with you based on your previous experience. MAC anesthesia is commonly used without the side effects some experience with general anesthesia. We also include ant-nausea meds in the anethesia to ensure you are comfortable.  The anesthesiologist with remain at your bedside for the duration of surgery.Be sure to find a very experienced gynecomastia surgeon. The results can be incredible and truly life-changing. It is my favorite surgery to perform. I love seeing both the immediate and the long-term results from my very happy patients.

Most of our gynecomastia cases are done under a "lighter" form of general anesthesia using an LMA which means the patient is breathing the entire time on their own although completely asleep. The anesthetic wears off quickly leaving patients feeling better that they might have using older forms of general anesthesia. We feel it is important and safer to work with board certified anesthesiologists in the ORs where we work to give the patient the safest and best experience. Gynecomastia surgery has a very high satisfaction rate so good luck with the procedure..Dr.Price