Risk Of General Anesthetic with COPD For BA- What About Local?

You are asking for a green light to have cosmetic surgery in a country far from home presumably because it is cheaper than the price at home in the face of a respiratory impairment that is not clearly described. No one in their right mind would give you that greenlight based solely on the information in your post.

You describe reversible (asthma) and irreversible (COPD) lung disease which can exist together. This is a tricky situation because even if the lung function tests are normal the reversible component can kick in due to irritation of the breathing tube in general anesthesia, dehydration associated with any surgery or even pain medications used during surgery. Furthermore, significant impairment of lung function can occur in asthmatics without symptoms. The history and general physical examination may not accurately indicate the severity of the asthma. The answer is not to just do it under local because you think it would be safer. If you have an asthmatic attack induced by the procedure and cannot have a breathing tube placed because of the spasm you will not survive. The answer is to do the surgery in an environment where should any of these problems arise the right personnel and equipment are present to handle the situation.

Only asthmatics with stage I disease and a forced expiratory volume greater than 75% of predicted values can undergo surgery without a higher than normal risk of airway complications. Any asthmatic who has taken steroids within 6 months of surgery needs perioperative steroids to cover for diminished adrenal function.  So you see it is a little more complicated than a simple green or red light.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Hi there- 

Given the additional information you have provided (thanks), it would seem that your lung function is better than might have been assumed.

In any case, it would be a good idea to have your lung function actually evaluated, so that the procedure might be made as safe as possible for you. Remember- this is elective surgery that we're talking about... it doesn't make any sense to take even the slightest unnecessary risk.

With regard to local anesthesia, I would say that if you remind yourself that the goal of the breast augmentation procedure is to SAFELY achieve a larger, more shapely breast profile, that trying to place implants in an awake patient under local compromises both (IMO).

Finally, I would agree with my colleagues who pointed out that having surgery outside the country in which you live will not only increase your risks, but may make it very difficult to find a doctor at home willing to see you should you have a problem on your return. You should think about this carefully.

 

The diagnosis of COPD is not a measure of your available lung function, it's a label.  Before considering a GA I suggest talk with your GP and obtain a referral for lung function tests.  If you are only mildly compromised then a GA will be fine, if you lungs are severely damaged then you are at risk of death if a GA is undertaken and it would be a mistake to consider it. There are several causes of death through anaesthesia in the context of COPD.... respiratory failure, lung collapse, pneumothorax, and so on. Don't want to frighten you but the point is that there is risk only of you are severely affected.

Going to Thailand for an augment if you have significant COPD is simply placing yourself at a substantial risk and potential costs if you needed help after the operation.  It would be much cheaper to do it locally, and safer, than that.

Good luck.

I would recommend that you consult with your pulmonologist to determine whether or not you are a good candidate for surgery.  Recent pulmonary function testing should be part of your evaluation.  If your COPD is severe, respiratory problems can still occur with the procedure being done under local anesthesia.  In addition, postoperative pain can diminish your respiratory function if your COPD is severe. 

I would be very nervous about going overseas to have the procedure done.  Even if you have a great surgeon complications can occur and could create a real problem if you are overseas.

Breast reduction should not be performed under local anesthesia. If you have COPD, I would encourage you to discuss any prospective surgery plans with your treating pulmonologist. When medical tourism to a country which may not have the same high standards is involved, it is imperative that you disclose the condition to your prospective surgeon and that you not risk surgery unless and until your pulmonologist clears you to do so. You should have current, stable pulmonary function studies and understand that failure to inflate the chest by deep breathing after surgery could have consequences for your pulmonary condition and increase the risk of pneumonia. I personally would not perform a cosmetic operation on a patient with anything but the mildest variant of COPD.

Breast Augmentation can be done under local anesthesia with sedation(not local alone) or with general anesthesia.  It would be in your best interest to consult with your primary care doctor and a pulmonologist to determine your lung function to see if the procedure would be safe.  You should be cleared for  general anesthesia even if local with sedational anesthesia is planned.  Lastly, travel outside of the country for the surgery would most likely be even more risky especially with a history of COPD.

While breast augmentation can be done under local anesthetic (if placing the implants above the muscle), it is always better to consider safety and potential breathing issues in case deeper sedation is needed. This really needs to be discussed with your primary care doctor and your surgeon - there severity of your COPD needs to be considered. Going outside the country is not a good idea since you may not have much support if problems occur.

Thank you for the question.

It will be very simple to determine whether you should consider breast  augmentation or not. Have your pulmonologist do formal pulmonary function tests.  If he/she determines that the results of the testing will allow you to have a general anesthetic safely then you should consider the operation.

In general, it is best to enter the operating  room only if you are a good candidate for  general anesthesia;  even if the procedure is scheduled to be performed under local anesthesia,  it may have to be converted to a general anesthetic  for a variety of reasons.

If your pulmonary function tests are not  “passing” then don't consider the operation.

I would also not suggest having the operation outside your home country unless absolutely necessary.

I hope this helps.