Breast Implants - While being awake during surgery.

Anesthesia seems to be a concern to many patients. I believe that a breast augmentation, especially a submuscular placement needs to be done under anesthesia. There are different types of anesthesia; general, intravenous sedation also known as twilight anesthesia and local. A lot of plastic surgeons use general anesthesia. I personally prefer intravenous sedation or twilight anesthesia. You do not have a tube placed down your throat, you are breathing on your own, you are monitored by an anesthetist just like at a hospital (I do my surgeries in my certified office surgery suite). I also place tumescent solution ( lidocaine/epinephrine solution) into the breast tissue which makes the operative area numb and bloodless. This also provides postoperative pain control, negating a pain pump. Strictly, local anesthesia is more unsafe due to the large dose of anesthetic that have to be given which can lead to seizures or even death. See a board certified plastic surgeon for an in person consultation and discuss your concerns. I've done breast augmentations under intravenous sedation since 1996 without one untoward surgical or anesthetic outcome.

There are a few things that have to be considered when looking for where to have "awake" breast implants.   First, you need to consider safety.  Second, is surgeon experience and qualifications. While general anesthesia has some very small risks, having any kind of surgery in an inappropriate setting without safety measures by someone who doesn't have experience may be much less safe.   Make sure that you are seeing a board certified plastic surgeon, who has nearby hospital privileges and the ability and option to perform breast implants in the hospital under general anesthesia before you decide to have it done by that person awake in their office.  No one is really completely "awake".  Local anesthesia is used to numb up the breast area along with oral sedation (pills like valium or xanax given right before the procedure to relax you).   Even though you are awake, you may or may not be aware or remember everything afterwords.  Unfortunately, there are many doctors who are not plastic surgeon who are unable to get hospital or surgery center credentials.  They often offer "awake" surgery in their office because that is the only place they can do it.  The other problem, is that many board certified plastic surgeons are only comfortable with general anesthesia and have little or no experience with oral sedation for "awake" method.The best way to find out where and who is to do your research.  Make sure the doctor is qualified.  Go see the the doctor in consultation before you make the decision.  And finally, make sure this is what you really want.  Although I perform "awake" surgery, most of my patients actually prefer to be asleep and not remember anything.   

Thank you for the question. Every surgeon will have his/her preference. I prefer the use of general anesthesia provided by a board-certified anesthesiologist.  I have found that the  use of general anesthesia is safe, comfortable for the patient, and predictably maintains a patient in a good position (without movement)  during the procedure. I think the latter is important as we are trying to achieve as much symmetry is possible. Some anxiety is normal; you will likely find that once you develop a sense of confidence with your plastic surgeon and his/her team, your anxiety will be manageable. Best wishes.

Thanks for your question.Breast augmentation is significant surgery and some anesthesia is required.  The question is what level of anesthesia is best for you.Keep in mind that anesthesia performed by an experienced anesthesia provider is very safe.Best wishes, Dr. Connall