Is Local Anesthesia Safe? What Can I Expect During Surgery?

First off I want to thank all the advice I got on my last question! A lot of you advised me not to go 800cc HP saline.. After talking to my PS he also agreed so we have agreed on 700cc Mod+ Saline(under muscle) :) Now with that said my PS uses Local Anesthesia (he mentioned something about versed) I just don't want to wake up and PS still doing my surgery!? Or I feel anything?!

Doctor Answers 17

I don't want to feel anything.

Still recommend against large saline implants, and definitely against such implants being placed in submuscular position under local anesthesia, for a variety of reasons.  Your body is the most precious item you will ever own.  Take care of it, and entrust it only to those who consider your trust most sacred.  The goal of this surgery is for you to feel beautiful.  The studio, the paints, the brushes, and the artist must all be of the highest caliber and quality to produce a masterpiece.

San Diego Plastic Surgeon
4.9 out of 5 stars 47 reviews

Should You Have Breast Augmentation Under Local Anesthesia

Some patients are very nervous about general anesthesia. Often this is because of stories they've heard, or simply a lack of information or understanding of the types of anesthesia. Some think that  surgery under local anesthesia  is a good option when having Breast Augmentation surgery. General Anesthesia is the most common type of anesthesia, and is the most preferred method by Plastic Surgeons. It is the safest method, if administered by a Board Certified Anesthesiologist in a Certified and well equiped surgery center. And, there is usually no real cost saving having surgery performed under local, as the sedation should be administered by the Board Certified Anesthesiologist in either case (local anesthesia or general anesthesia). Patients can have adverse reactions to local or sedative anesthesia and you would want someone trained to deal with this type of emergency should it arise. I'd recommend the article below, which address issues of anesthesia in detail.

Robert N. Young, MD, FACS
San Antonio Plastic Surgeon
4.6 out of 5 stars 70 reviews

Local anesthesia is safe, but is it wise for breast augmentation?

All board certified plastic surgeons have experience with local anesthesia, sedation techniques and general anesthesia.  Most of us prefer general anesthesia for breast augmentation, as you can tell for these posts.

I have used local anesthesia with sedation (like you are describing) for breast augmentation in the past, but  I do not offer this option any longer.There is a limit on the amount of local that can be used without harming the patient. I  found that no matter how much or what form of local anesthesia I used, I could not get the patient totally comfortable.  Even if the sedation makes the patient forget, it is hard for the doctor to ignore the patient moaning and trying to climb off of the operating table.  It also make maintaining a sterile field quite diffcult.

Please give this some careful thought.  You may want to rethink the 700 cc saline implants some more.  Based on the previous information, I am concerned it might be too much for you tissues to handle.

Good luck.

Michael S. Hopkins, MD (retired)
Albuquerque Plastic Surgeon
4.9 out of 5 stars 83 reviews

Local anesthesia versus general anesthesia for breast augmentation

As a board certified plastic surgeon who has done thousands of breast augmentations under local anesthesia with IV sedation in a certified facility, I am obviously biased but also used to dealing with the various misconceptions about local vs. general anesthesia and the preferences of plastic surgeons who don't have the experience to do breast procedures under local anesthesia. 

Anesthesia means putting to sleep. This can either be local (for the area being operated on), regional (a part of the body as in a spinal or epidural), or general (the entire body). It is not necessary to put your entire body to sleep in order to operate on your breasts and accept the risks, costs, and recovery issues that go with it. It is quite possible with modern technique and anesthetics to put your breasts to sleep and operate on them as in putting an area of skin to sleep to excise a mole. Think if it like your nose. It is fairly easy to put your nose to sleep with local anesthetics and do a rhinoplasty procedure. The problem is that the process of injecting the local anesthetic and carrying out the surgery is not something most people want to be aware of. Even colonoscopies that don't involve anesthesia are done under IV sedation these days. Oral surgeons use it for dental extractions commonly. 

IV sedation is not anesthesia and you are not put to sleep. Properly done it can make you feel like you were asleep and often have no recollection of the procedure done under local anesthesia. The IV and appropriate monitoring is required to allow for control of the proper sedation level. This actually doesn't have to be done by an anesthesiologist or nurse anesthetist unless they may want to convert the procedure from IV sedation to general anesthesia. The key is that the local anesthetic has to be done properly. The body part in question must be put to sleep. You cannot cover up inadequate local anesthesia with sedation. The other reason for sedation is so that the patient can cooperate and not move around or get out of control with an open operative field. This requires experience on the part of the operating surgeon and many plastic surgeons either don't have this experience or just prefer someone else to put the patient asleep and they operate on them. 

I view this as the patient's choice. I could easily do the same procedure under general anesthesia if the patient prefers it but there are costs, risks, and after-effects of general anesthesia that patients generally want to avoid if given a choice. Surgeons who are not experienced with IV sedation/local and don't have an accredited facility for that level of anesthesia are not able or shouldn't give the patient that choice. 

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

Anesthesia and breast augmentation

A breast augmentation can be done under local but I fell only with sedation. I think it would be too uncomfortable for most patients to handle this without some sort of sedation.  Most use general anesthesia.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Best Anesthesa for Breast Augmentation

Breast Augmenation can be done under local Anesthesa, local Anesthesa with Intravenous sedation or with general Anesthesa. The fact that he overwhelming majority of Plastc surgeons perform Breast Augmentation under general Anesthesa readily suggests which form of anesthesia is he best.  The comfort provided by local anesthesia using tumescent solution similar to the one we use in liposuction, does not approach the level of general anesthesia. The addition of intravenous medication to supplement  local infiltration of anesthesia is intended to make the woman less anxious, less mindful and forgetful of the pain and discomfort of local anesthesia. comparing this to the absolute comfort of the woman, the lack of sudden movement and unmatched visibility enabled by general anesthesia allow quicker, more accurate and much more comfortable breast augmentation surgery. 

The vast majority of Breast Augmentations done under local anesthesia are done by doctors who CANNOT offer general anesthesia to their patients; in other words, non-plastic surgeons performing Plastic surgery. Hospitals and Medicare or AAAASF-certified operating facilities allow only formally trained Plastic surgeons to operate in their facilities. Because of the heavy cotsts of malpractice insurance and of bad press they do not allow Family Practice, ER medicine, Dermatology or Ob-Gyn to perform such operations inside their walls. Only Plastic surgeons are allowed to perform  Plastic surgery. 

As a result those rejected nn-plastic surgeons who persists and wish to perform Plastic Surgery procedures are LIMITED  to only having an inferior and basic anesthesia alternative for Breast Augmenttion: local Anesthesa. And to get people to buy not it they put out unsubstantiated claims to its superiority. I seriously suspect your surgeon may fall no this group. I old proceed with caution. 

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 109 reviews

Is Local Anesthesia Safe for Breast Augmentation Surgery

Many patients are afraid to have general anesthesia. They think that avoiding general anesthesia at all cost, and by having their plastic surgery only under local anesthesia, they are making the best decision for themselves. Unfortunately, this is not true! General Anesthesia is a most commonly type of anesthesia used for major surgery, and it is the safest, if give by a Board Certified Anesthesiologist in a Certified and well equiped surgery center. It is more risky and fare more uncomfortable to have breast augmentation under local anesthesia than under general anesthesia.

Sean Younai, MD, FACS
Beverly Hills Plastic Surgeon
4.4 out of 5 stars 49 reviews

Breast Augmentation Decisions

First off, be very leary of such a large size implant.  I'm sure you have a clear idea of what you want, but when the size is greater than 400 cc, the chance of complications goes up.  As for your question, local with IV sedation can be successful in experienced hands.  Your best move is to really do your homework regarding the surgeon and talk to some patients. 

Justin Yovino, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 93 reviews

Breast Augmentation under Local Anesthesia?

I believe the best way to have this procedure done in your case would be under general anesthesia. When you describe your goals of “not wanting to wake up or feel anything”,  it becomes very clear that you will do much better under general anesthesia.

Please make sure you are working with a well experienced board-certified plastic surgeon. Look at lots of examples of his work. Is the procedure being done with the help of a board-certified anesthesiologist? Is there facility where the procedure is being performed fully credited?

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

Local Anesthesia for Augmentation

I guess I'm the wrong one to ask. I have not done a breast augment under anything but general anesthesia in 20 years. Sometimes a patient will ask me if they can get the surgery done under local with sedation and I always reply "of course, just not with me." It is cetainly as safe to do local with sedation AS LONG AS you have a board certified anesthesiologist administering the sedation. My impression over the years from talking to many surgeons around the country is that for the most part the only surgeons doing this under local with sedation are those that do not have a surgical facility set up for general with an anesthesiologist on staff.  So can you do it? Sure. Would I do it? No. What if the local isn't working? You have two options. Keep at the surgery and put up with the pain or stop the surgery and come back another day. Which would you prefer? And one last thing - 700cc is still way too big for someone with your frame.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.