Thoughts on twilight sedation along with local anesthesia for breast augmentation?

We do not offer twilight anesthesia at our practice. The preference is to have to patient totally asleep to make the surgical flow as smooth as possible. Many practices are well set up for twilight and works well for them. The best course of action is to discuss with your surgeon including any concerns and come up with a plan together. As always, be sure to research who performs your surgery to ensure the best likelihood of a positive result.

Hello, thank you for your question. There are several options for anesthesia during surgery. Both forms that you mention are good ones for the right patient. Best to discuss this with the anesthesiologist for your procedure.

Thank you for your question. General anesthesia vs IV sedation are both safe if administered by an anesthesiologist or a CRNA. I always used IV sedation combined with tumescent anesthesia as local in all my submuscular augmentations for the past 24 years. I am talking about deep IV sedation, twilight means light sedation by the surgeon's nurse that keeps you awake but somewhat sleepy. I would not recommend that. Intercostal nerve blocks can be done as an adjunct, mainly to control postoperative pain. I do not advocate that, there's a risk of pneumothorax as it was pointed out and we have much better pain control postop nowadays. Pain control starts with the gentle, bloodless dissection by the surgeon. The tumescent solution placed in the submuscular pocket during surgery makes the dissection bloodless and provides postop pain control for the first 6-8 hours. Early pain control leads to less use of narcotic pain medications later on.
Good luck with your surgery.

I have certainly performed many augmentations under sedation. I think you should find out whether the sedation will be given by an anesthesiologist or a nurse.

Dear Beautiful650204,that can be an option for well selected patients. However, most plastic surgeons will recommend general anesthesia. 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

For many years, I offered IV sedation with local anesthesia or general anesthesia to my patients, and most preferred the IV sedation. Both types of anesthesia were provided by anesthesiologists or nurse CRNA's well trained in both types. For patients who need capsules removed, especially with the old gel implants, I do prefer general anesthesia.

Thanks for your question. Breast augmentation can be performed safely with either anesthetic. I do prefer twilight sedation which allows for a safe anesthetic with quick recovery, and lessens the risks for post op nausea and vomiting. Good luck.

The type of anesthesia used is a decision made by a combination of the anesthesiologist and surgeon. You should have input into this decision, but the safety of the patient lies in their hands.
I use sedation on all of my submuscular breast cases without issue. There are a select few who are converted to a general anesthesia (either with just a mask or in rare cases, an LMA due to either anatomical airway issues or poor tolerance of the IV sedation).
That comment about a pneumothorax is EXTREMELY rare. I've never seen or heard of one from a nerve block during an augmentation. I have heard of pneumothorax during a regular submuscular breast augmentation but that was surgeon's error.
If the anesthesiologist is comfortable and regularly uses sedation, then your fine.
Good luck with your procedure.
Dr T

For surgeons that know how to do it, twilight sedation is a great option. Less postop nausea, less pain (my experience), and faster recovery. GA is preferred by surgeons by far because it is easier. Good luck!

The anesthesia is a personal choice, both general and heavy IV sedation are acceptable techniques. The advantage of IV Sedation and Intercostal blocks plus local infiltration is not only a safer approach but also has significant less post-operative pain. This is the technique I prefer in most of my augmentation mammaplasties.