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.

Breast augmentation can be done with either IV sedation or general anesthesia. I have abandoned the use of IV sedation for the most part as patients do better in my opinion with a general anesthetic.

Aloha,Thanks for your great question. Both are very safe, but I agree that recovery and side effects are better with IV sedation. As important is the person giving the anesthesia; I've used the same certified anesthetists for >20 years and my patients love them.Mahalo, Dr D

Thank you for the question.Every surgeon has their preference. I prefer to use general anesthesia performed by a board-certified anesthesiologist. I have found that this provides a safe and comfortable experience for the patient.

Breast augmentation is done both ways but I prefer general anesthesia for my patients safety, comfort and ease of operation.  Most augmentations are placed under the pectoral muscle and this requires some division of part of the muscle.  Sedation and local anesthesia can keep a patient comfortable during this part of the procedure but occasionally the patients can have discomfort and become restless.  With general anesthesia, all parts of the procedure are performed without any concern of the patient having discomfort. General anesthesia is very safe and recovery is also very fast.  For the best patient experience I recommend general anesthesia.

I offer both IV sedation as well as general anesthesia for my patients who undergo cosmetic surgery.  There are a lot of factors which allows us to chose one over the other.  If the individual is smaller i.e. less than 130 lbs and does not drink too much alcohol she would be a good candidate for IV sedation.  Using IV sedation also necessitate the surgeon being able to do a good job numbing the area that's being operated upon.  Many surgeons are used to general anesthesia and do not do as complete of a job numbing the area.  If the breast area is carefully numbed with local there has to be very little IV sedatives given and the patient tends to wake up quicker and less likely to be nauseated due to the use of narcotics.  I generally use general anesthesia for longer cases or revisionary cases of breast augmentation where there would be more IV sedatives used vs anesthetic inhalational agents given.  The key is when the surgeon is a member of the American Society of Plastic Surgeons he must operate in an accredited surgical facility and employ the use of a Board Certified Anesthesiologist to make sure the best safety for the patient. 

Both options should be weighed by the surgeon and the patients. Both are safe if done correctly by experienced anesthesists for the appropriate patient. The recovery from IV sedation is quicker and has less affects such as nausea and vomiting. General anesthesia reduces the movment of the pectoral muscles and enables better pocket dissection with better control and homeostasis in my experience.Good luck!

Hello and thank you for your question.  General anesthesia is much safer in today's era than it used to be. I use board certified anesthesiologists who know what type of anesthesia is best for our patients.  We have found that patients are more comfortable during the procedure with general anesthesia and that we are able to give muscle relaxers and paralytics during the surgery without as much risk to the patient. Having the muscle paralyzed when it is cut during a dual plane or submuscular augmentation is important to prevent tearing of the muscle during the dissection; also, it is more comfortable this way and allows for better "pocket control." Furthermore, general anesthesia allows you to be fully relaxed for the surgery, and while the anesthesia recovery is a little slower than with IV sedation, the soreness you feel is usually less and a quicker recovery from the surgery itself.  No matter what, make sure to go to a board certified plastic surgeon for your plastic surgery and make sure that whoever is administering your anesthesia is also board certified in anesthesia and that you are not getting drugs through an IV by their clinic nurse.  I hope this helps!Sincerely,Dr. Sean Kelishadi