Is it possible to get an explant under twilight sedation?

Question

I would like to remove my breast implants. They are roughly 9 years old, no problems with them, simply don't want them any longer. Is it possible to get an explant removal under twilight sedation or something similar w/out going under? I have had 2 kids since & wondering is it possible to do a lift under twilight sedation as well if it is determined one is needed? How do I find a board certified physician to do a procedure that doesn't require me to go completely under (just call around)? Ty!

Jed H. Horowitz, MD, FACS · Answer

hello lilac1633  The procedure is an outpatient operation performed under oral sedation, IV sedation, or general anesthesia depending upon the length and complexity of surgery. #post-op #sedation

Christine Rodgers, MD · Answer

HI Lilac, The breast implant removal can be done under sedation unless you have ruptured implants with a hard capsule around the ruptured implant material. If you have hard scar tissue, it would be better for you to have a general anesthetic, especially if the implant is beneath the muscle. I think that every case is unique and you should see a Board certified plastic surgeon for a personal exam to see if you are a candidate for the procedure under local anesthesia with sedation. The breast lift part is a bit more complicated. The answer to this question depends on how large you are and how much work has to be done. Again, the best way to answer your question is with an in person exam by a plastic surgeon.Good Luck,Dr. Christine Rodgers

York Jay Yates, MD · Answer

Implant removal +/- capsulectomy and a lift are all possible under sedation without general anesthesia.   It requires excellent local anesthetic techniques to do this appropriately.  Sedation level can be tailored to each patients wants/ needs.   We most commonly use a TIVA anesthesia where the experience feels like a nap.   No awareness (although it can be lightened to achieve this if desired).   No intubation necessary.   Muscle tone in the legs is preserved minimizing DVT risk and the wake up is generally quite pleasant and easy.

Daniel Barrett, MD · Answer

Dear Lilac1633,removal of breast implants is a straightforward procedure and it can be done under light sedation. However, most plastic surgeons will require a general anesthesia for a breast lift surgery. Another option is to remove implants now and wait a few months to see whether you will need a breast lift.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Richard H. Fryer, MD · Answer

I routinely remove implants in my office using only local anesthesia (as long as they are not textured implants and as long as they are not ruptured silicone.I also encourage my patients to then wear a tight fitting sports bra day and night for 6-9 months before deciding IF they want/need a lift.  I have had very few women return wanting a lift.

Tom J. Pousti, MD · Answer

Thank you for the question.
Generally speaking, removal of breast implants can be done under local anesthesia and is well tolerated by most patients. However, when additional procedures are necessary ( such as removal of thickened  breast implant capsule),  additional anesthesia may be necessary to ensure patient comfort and an appropriate level of anesthesia to perform the procedure safely.
If the scar tissue (capsule) Is significantly thickened it will likely be in your best interest to have it removed at the time of removal of breast implants.
Best wishes.

Robert Whitfield, MD · Answer

So I would like to recommend you be careful about what you are being advised about.  Implant removal and complete capsulectomy performed for ASIA, BII or any reason fro that matter is not something to be taken lightly.  IV sedation for a case like this would be similar to a general anesthetic.  I do these cases weekly and have several the day after Christmas.  These cases can become quite involved so it is important to actually get have an appropriate consultation.  I will attach a link about BII and implant removal.  The video has over 130k views.  It is pretty self explanatory as well as the information on the page.

Richard J. Brown, MD · Answer

So first. There are a few places you can find the surgeon. You can try to go to the American Society of Plastics Surgery website and search for a board certified Plastic Surgeon or you can to to our aesthetic society website The American Society of Aesthetic Plastic Surgery and do the same. Then you should search that doc on google in your town and make sure they are legit. This is the most important part of the conversation we will have here in this response. Second, sure you can remove implants under sedation but if they are textured implants it may be very uncomfortable. If they are smooth round implants they should pop out no problem under twilight. If you have a lift you need to be asleep no question. I am sure you will find someone who will do it under sedation, but I personally think that is a bad idea because that surgery is at leasts 2 hours unless you are lightning McQueen. Whether you need a lift or not should be determined in the office before you have explantation. It is pretty cut and dry.

Camille Cash, MD · Answer

You may be able to undergo implant removal with moderate sedation.  Not all surgeons offer this, so you will have to check with your surgeon for your options.  If the capsules need to be removed or if there is a rupture with the implants, general anesthesia will be necessary.

Scott L. Replogle, MD (retired) · Answer

All breast surgery can be done with local anesthesia and IV sedation without an anesthesiologist or general anesthesia, but most plastic surgeons aren't trained or set up for this. Simple removal of saline-filled breast implants can even be done with just local anesthesia without even the IV sedation. The decision for a lift has to do with where the nipples sit in relation to the inframammary crease and not the implant removal. That decision should not be made at the time of the surgery and a lift would add considerably to the surgery and can still be done with local anesthesia and IV sedation, but again, most plastic surgeons aren't trained in this and can't offer it. I would look for a plastic surgeon who can do the simple implant removal under local anesthesia and minimal sedation in the office setting and then decide what, if anything, to do for the breasts after seeing how they look without the implants.

Is it possible to get an explant under twilight sedation?

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