Breast augmentation: general anesthesia vs. IV sedation?

The use of IV sedation or general anesthesia is generally a choice of convenience for the surgeon.  But what really matters is the patient experience in my view.  I prefer IV sedation administered by a board certified anesthesiologist because the recovery is so much easier and faster.  Most of our patients are alert and able to ambulate within a short time after the end of the surgery.  We have much less post-op nausea and all patients are adequately sedated without any awareness during the procedure.  

Thanks for your question!Breast augmentations can be done either way, under IV sedation or general anesthesia.  IV sedation is less invasive as less medications are used for anesthesia and there is no placement of a breathing tube.  Cost is less as well.  However, I do not perform breast augmentations in this manner.Safety is a major concern.  While some surgeons will use another doctor, an anaesthesiologist, to administer the IV sedation during the procedure, some surgeons don't.  This would mean that IV sedation is done by a nurse or technician, or even the surgeon themselves.  I feel this is less safe than having another doctor taking care of you along with your surgeon (who should be concentrating 100% on your surgery!).Each surgeon performs this surgery in a different way.  In our case, we are known for an armpit incision, endoscopic approach.  During the surgery, the arm is placed at 90 degrees from the body so that the armpit region is accessible.  This wouldn't be possible under local anesthesia.  We choose not to use an incision on the breast for our patients as incisions and dissection through the breast damages the breast, leading to a possible loss of sensation or loss of future ability to breast feed.  In addition, the armpit scar heals very well and is in most cases invisible.  Scars on the breast can heal well, but sometimes can be very obvious as they are on the breast.Most augmentations are done submuscularly.  When the implant is placed under the muscle layer, the muscle needs to be cut where it is attached to the ribs.  This is a painful surgical maneuver and I do not feel IV sedation is sufficient to make part of the surgery comfortable.In our practice, we use temporary sizers to determine the best size for patients.  Patients often have asymmetry one side often needs a larger implant.  To best gauge this, we view the breasts from both a seated and flat position by changing the position of the mechanical OR table.  Changing a patient's position like this while you are partially awake just isn't possible.  General anesthesia is required, in my opinion, to get the best symmetry of the breasts and for you to be comfortable while this is happening.General anesthesia can be a very safe procedure and can be designed around the fastest recovery possible when done by a skilled and board certified anesthesiologist.  We inject local anesthesia while you are under general anesthesia so that patients often wake up with little pain.I really feel the best experience with a breast augmentation will be from a patient falling asleep, having the procedure smoothly and painlessly with general anesthesia and waking up with the breasts they wanted with minimal discomfort.  Aloha,Shim Ching, MD

I
perform breast augmentation exclusively with IV sedation. In fact, our Surgery
Center avoids general anesthesia on all of our cosmetic patients whether it is
for tummy tucks, face or breast surgery. Be sure that your provider is
comfortable with this option for you.