“Twilight” sedation for breast augmentation?

Question

I’m having a breast augmentation on April 26th. My surgeon is using “twilight” for sedation. However, my surgeon is the one sedating me, I will not have an Anesthesiologist.. I really don’t know how to feel about it. I feel safer for an actual Anesthesiologist sedating me. Advise? Any good questions I should ask my surgeon?

Daniel Barrett, MD · Answer

Dear kperry3,
“Twilight” sedation can be used for breast augmentation. However, I prefer general anesthesia because it allows me more comfort in order to get the best results. 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

Jonathan Heistein, MD · Answer

Although it is possible to have breast augmentation with "sedation" anesthesia, and although it is possible for this to be provided for by the surgeon, I have always felt that the surgeon should be focused on the surgery and another trained professional, either anesthesiologist or CRNA, can be focused on making sure you are safely tolerating the procedure by monitoring the anesthetic.  If you are uncomfortable with the situation, then you should discuss it with your surgeon... not on the day of the surgery.  In the end, you should not do anything that you don't feel comfortable with.

Zoran Potparic, MD · Answer

We would occasionally perform breast augmentation in twilight anesthesia but only if implants are placed above muscle (subgladular). Placement underneath the muscle would require general anesthesia in our experience. In both cases, twilight or general, anesthesia is provided by CRNA or anesthesiologist in our practice. Good luck.

Nelson Castillo, MD · Answer

Thank you for sharing your question. Some surgeons do train in order to be able to perform different forms of anesthesia but I do all of my augmentations with a board certified anesthesiologist present for safety and in order to focus on the job at hand.

Kenneth Hughes, MD · Answer

Twilight sedation puts you into a deep state of relaxation, but it doesn’t numb the body or block pain, which is why your doctor will still need to use local anesthesia. Ask your board certified plastic surgeon to explain the benefits of using "twilight" over "general" anesthesia. This will convince you of the safety of the procedure and quicker recovery.

Robert M. Tornambe, MD · Answer

I appreciate your concerns, and I agree with you.
 While many cosmetic procedures can be performed safely and effective under local anesthesia with so called twilight sedation, I do not believe breast augmentation falls into this category. A deeper form of anesthesia is needed to allow the surgeon to perform effective dissection of the pocket for placement of implants, and this is best provided by board-certified anesthesiologist or CRNA. Discuss your concerns and desires for an anesthesiologist with your board-certified plastic surgeon. Good luck.

Connie Hiers, MD, FACS · Answer

Yes, it is always safer to have an anesthesiologist sedate you while the surgeon is busy doing surgery, unless the sedation is with oral medication. I would suggest asking more specifics about this sedation. Most surgical facilities do require anesthesia to be present, either nurse or doctor, while giving IV medication for sedation.

Douglas J. Raskin, MD (retired) · Answer

Greetings,

This is a challenging issue for a patient to consider.  Older plastic surgeons remember decades where many of us sedated our patients safely for cosmetic surgery procedures.  You have the responsibility to evaluate/investigate if your surgeon has an impeccable track record with his sedation patients.

If you are uncomfortable with “Twilight” sedation for breast augmentation, seek other opinions for your care.

Best Regards,

“Twilight” sedation for breast augmentation?

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