Minimal IV Sedation W/ Local Anesthesia in Seattle Area? (photo)

Hello, I've had couple of consultations in the past. I'm a good candidate for Sub-glandular placement - I have been wanting Breast augmentation but I can't grasp the idea of getting General Anesthesia - sounds like an open heart surgery, it terrifies me, plus I know I've I'm to medication. I have an active lifestyle, running, cycling, healthy 41 y/o. I'm looking for a Board certified plastic surgeon who would do Minimal IV sedation, w/ local anesth. in Seattle area.

Doctor Answers 20

Breast surgery in Seattle - maybe time to revisit everything

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I think this is the third posting from you recently so you apparently haven't heard what you want to hear.  With all due respect and understanding your fears, I would suggest that you revisit this whole process from a different standpoint.  Rather than deciding yourself what you are a good candidate for, maybe ask the most experienced surgeons what would give you the very best result. 

Not only am I concerned that you are shopping for a doctor who will use whatever anesthesia you want, but I am also concerned about placing an implant above your muscle where your mammograms will be more negatively impacted and there is probably a higher risk of capsular contracture.  Not to mention that your photos seem to show some droopiness of the breast which will not be fixed by above the muscle placement.  Implants without a lift in somebody who needed a lift look worse than if they had done nothing at all.

You wouldn't tell a pilot how to fly the plane, so pleas understand that it is best not to shop for a doctor who because they need your business will just tell you what you want to hear.  Anesthesia by a qualified doctor of anesthesia is a very safe thing in a healthy patient.

IV Sedation With Local Anesthesia for Breast Augmentation?

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This question seems to keep coming up, suggesting that the reader is not getting the answer that they want. Also, if your goal is to get the best longterm result, then your focus should be much more on the surgeons skill and experience, rather than on the type of anesthesia. 

But to make this a more complete overall educational experience let's talk about the anesthesia and the surgery. Yes it is possible to do a subglandular augmention under local anesthesia but is this really the optimal way to do it. While I understand that people often have an aversion to general anesthesia because of things they have read or heard, modern general anesthesia techniques for short, limited procedures like breast augmentation are extremely safe. It is NOT like open heart surgery. At risk of being a little blunt, your concerns about general anesthesia are not rational. The risk of having a serious complication from a general anesthetic performed by a well trained anesthesiologist is much lower than that of getting in a fatal motor vehicle accident on any day. Yet you jump into your car everyday without thinking twice about it, but you are actually safer asleep under general anesthesia. In addition, there is no "minimal" IV sedation for breast augmentation. It might require quite a bit of sedation to get you calmly through the procedure, and at a certain point this could be much more risky than general anesthesia.

Finally, is local/sedation optimal for performing breast augmentation surgery? To make you comfortable a large volume of local anesthetic or even more tumescent anesthetic must be injected into the breast tissues to make you numb. This results in distortion of the shape and size of the breast and can limit the surgeons ability to make subtle intraoperative adjustments to the implant size or creation of the implant pocket to give you the optimal overall result. So you potentially compromise your longterm result for the sake of having it done under local with sedation. 

Now let's talk about implants. It is really impossible to tell from your one photo whether or not you would be a good for subglandular implant placement. It is easier to do a subglandular augmentation under local/sedation, but is this approach really best for you? Subglandular placement is satisfactory for individuals with thick enough tissues in their upper breast who also would be happy with a smaller implant size. In practice, this applies to only a relatively small group of patients. It is certainly true that subglandular placement of an implant is a associated with a higher incidence of capsular contracture and with visible rippling in the upper pole of the breast. The risk of the latter problem is greater the larger the implant size. If your are "saggy" then you might need a larger implant to fill out the skin envelope and thus you put yourself at increased risk for these longer term complications which can be difficult to correct. I have seen a number of patients for breast augmentation revision who had subglandular implants done a number of years ago under local/sedation because it sounded easier and was less expensive. Now they have large sagging breasts with visible rippling and easily palpable implants. I can tell you that this is not the result that they were looking for, but it is the result that they ended up with because of choices that were made at the time of their surgery regarding implant location and type of anesthesia. And Gel implants are not a quarantee that this will not occur. So I ask you, do you want to select a surgeon based on the type of anesthesia they will use, or do you want to select you surgeon based on who will do what is best to achieve the optimal longterm result. You choose. 

Minimal IV Sedation W/ Local Anesthesia in Seattle Area?

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Basically, you can always find a surgeon to do what you want. But the standard in USA is a light general with local. Just be careful. 

Hi again

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Hi Ysabel, I previously sent you an extensive response previously outlining where my practice has evolved regarding anesthesia choice as well as some other considerations. I recommend that you please, please educate yourself about your options regarding not only your choice of anesthesia but also the choice of implant placement, etc.. I do not charge for my consults; we will discuss the tradeoffs and advantages of your options. You have responses from several qualified plastic surgeons but like a dating site, why not meet all of us and then make your best choice. With the agents that we have these days and the expertise of our anesthesia providers, I will tell you that is how the professional physicians and dentists want it done in my office. I have an MD anesthesiologist provide the care. I realize that you want minimal but to be honest, recovery is not about the anesthesia but the surgery. We do a good job of minimizing the recovery despite the fact that I mostly do sub-muscular implants for many reasons. It is about the long term results not just immediate results and regrets later on. Please listen to this and Dr. Rand's response. We are looking out for your interests here. 



David Stephens, MD

Breast augmentation

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Breast augmentation can be done under local with sedation, although I prefer general anesthesia.  If the implants are placed sub glandular, it is much easier than sub muscular when done under local anesthesia.  You should speak with your surgeon and the anesthesiologist involved to discuss the options.  In Seattle, I recommend Dr. Jourdan Gottlieb.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 28 reviews

Best Techniques for Breast Augmentation

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Sub glandular augmentation is rarely performed by most plastic surgeons because of the significantly increased risks of capsular contracture and rippling. Most people who are still doing sub glandular augmentation do it so they can do the surgery in their office under sedation. This is not ideal. General anesthesia is very safe. Statistically, you are safer under general anesthesia than driving on the highway for an hour. I would strongly encourage you to get some other consultations.

John Squires, MD
Denver Plastic Surgeon
4.9 out of 5 stars 82 reviews

Breast implants with local anesthesia and sedation

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As someone who performs all of his augmentations under general anesthesia, I can tell you its very safe, and arguably safer than local with IV sedation where your airway is not controlled. Certainly surgeons who do the procedure under sedation will disagree. As you can see from the other answers, you should be able to find surgeons who will do it under IV sedation. Its just not what I feel is safest nor is it best for the patient from a comfort standpoint. Best of luck.

Paul Wigoda, MD
Fort Lauderdale Plastic Surgeon
4.8 out of 5 stars 30 reviews

IV sedation, local anesthesia, and general anesthesia

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I strongly disagree with the responses implying that general anesthesia is better for the patient. This is usually from someone who doesn't know how to perform proper local anesthesia for breasts or doesn't want to bother. General anesthesia is easier for the surgeon but not for the patient. There is also confusion over what sedation and anesthesia are. There is certainly overlap with drugs available today but general anesthesia means putting the entire body to sleep. This is great for some things but not necessary if the breast is all that needs to be asleep. Local anesthesia can put the breast to sleep. The IV sedation is so that the patient doesn't have to be aware of the procedure and usually remembers little or any of it. Therefore local anesthesia with IV sedation (controlled/monitored) is smoother, safer, has less side-effects, and can cost less than general anesthesia -- all advantages to the patient. 

General anesthesia is, however, quite safe and is still the most common approach for breast augmentation. A plastic surgeon doing breast augmentation under local anesthesia has to be quite comfortable and experienced with it but should offer general anesthesia to the patient if they prefer it. 

I also agree with Dr. Rand that there are other issues going on here and that subglandular placement of breast implants is nearly always a poor choice and has nothing to do with the choice of anesthesia. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Anesthesia for breast augmentation

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There are many misconceptions about general anesthesia.  For breast augments, it enables me to operate quickly and with less risk of complications.  I would not want you to move around on the OR table while I am dissecting the breast pocket.  "Minimal" sedation is a euphemism; it will take more than a minimal amount of relaxation or sedation to enable this operation to be performed safely and the recuperation from IV sedation can be more difficult than from general.  I would encourage you to find a plastic surgeon with whom you are comfortable and to arrange to meet with his anesthesiologist to discuss the details of the proposed anesthesia.

IV sedation with local anesthesia for breast augmentation

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Thank you for your question. General anesthesia and IV sedation with local anesthesia is safe. Some offices use general anesthesia to speed up the surgery, but the recovery in the surgery center or office will be longer. I personally prefer IV sedation and tumescent solution for my local anesthesia. This has 2 advantages: 1. the surgery is bloodless and 2. you, the patient will be comfortable postoperatively. Placement of implant, size and type of implant can be determined during a consultation with a board certified plastic surgeon. Good luck. BTW, Everyone has a right to his/her opinion, but do not believe that surgeons who answer your questions on this forum are doing it just to spend their time giving advise only, without the possibility or hope that you, the prospective patient might call to set up a consultation. 

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.