Should I request general anesthesia for my mastopexy instead of local anesthesia?

Question

I have surgery scheduled next month for lipo of the stomach and arms, and a breast lift. My doctor is going to do this under local anesthesia. Should I be worried about this? I have had previous work with this doctor under local but my breasts are currently 36DDD so I feel like there will be a lot of work to reduce and lift them. The doctor did not mention sedation or "twilight anesthesia", so I'm concerned he won't be able to do a good job with just lidocaine. Thinking of requesting general.

Andrea Marando, MD · Answer

Thank you for your question. 
Different surgeons tend to have their own personal preferences with regard to the choice of anesthetic for surgical procedures. However, the vast majority of plastic surgeons would normally perform the surgical procedure of mastopexy/uplift under general anesthetic. In selected cases it is possible to perform this kind of procedure under twilight and, when appropriate, I have done it. 
However, it depends on the surgical plan, expected operating time and,
to a certain extent, patient's preferences.

I would advise you to contact your surgeon and maybe ask him to speak to some of his previous patients who had the same procedure under local anesthetic under his care?

All the best.
Andrea Marando
Plastic and Cosmetic Surgeon
Manchester and London, UK

Krishna Vyas, MD, PhD, MHS · Answer

While some surgeons prefer local anesthesia for smaller or less invasive procedures, a breast lift, especially if combined with other body contouring surgeries, is generally performed under general anesthesia to ensure your comfort and safety. It is completely valid to request general anesthesia, especially if you feel that local anesthesia may not provide the necessary comfort and safety for such a comprehensive procedure. 
Some surgeons do perform breast lifts under local anesthesia, particularly if the procedure is less invasive (e.g., a small lift or just a minimal reduction). Local anesthesia alone can be uncomfortable for extended surgeries or multiple procedures, whereas general anesthesia ensures you're fully relaxed and unconscious throughout the operation. For more extensive lifts, general anesthesia is typically preferred for both patient and surgeon comfort.
Your surgeon should be open to discussing the anesthesia options and may provide additional insights based on their experience.
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Michelle Zweifler, MD · Answer

Liposuction of the stomach and arms could be done under local anesthesia in appropriate candidates.  Breast lifts with breast reduction are most commonly done under general anesthesia, or at least "twilight anesthesia".  Combining procedures, takes longer and patient comfort is important.  There are additional fees involved with general anesthesia vs. straight local and this should all be discussed with one's plastic surgery.

Vishnu Rumalla, MD · Answer

Thanks for your inquiry and I do not see a reason why you could not request general anesthesia--but I do not know if your health, etc precludes a general anesthetic.  Best of luck with surgery.

Daniel Barrett, MD · Answer

Dear pies6120,
lipo of the stomach and arms, and a breast lift are major surgeries and general anesthesia is a better option. Finding the right Dr. is extremely challenging especially with the number of online platforms and resources available. There a lot of great Dr's available. Make sure he/she is a board-certified plastic surgeon. Definitely check to make sure your choice specializes in the procedure you want and spend the time to read through patient testimonials. There is a number of different sites where you can check for reviews (Realself, yelp, google, etc.).You can always pick up the phone and call around also, find an office you feel comfortable with and set up a few consultations. 
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

If you are a DDD, then you would do better with a breast reduction, otherwise, you may sag again. If you are worried, then ask for general anesthesia. This will be easier on your surgeon as well.

David Mattos, MD · Answer

A lot of surgeons use local anesthesia when able to because it makes the procedure more affordable for the patient. In my practice, I prefer to do most of these under general anesthesia for comfort also, unless the breast lift alone is very small, only involves the areola, and perhaps a small area around that. Otherwise the patient may be uncomfortable. If your surgeon is hesitant to use general anesthesia, I would recommend meeting with another surgeon for a second opinion. Good luck!

Camille Cash, MD · Answer

Based on your surgical plan I recommend general anesthesia.  This is for your comfort and safety primarily, but also for your result. These procedures are detailed and would typically take several hours in total.  They would most commonly be performed under general anesthesia.

Douglas Taranow, DO, FACOS · Answer

While every surgeon has their preferred technique, I agree with you requesting deep sedation or even general anesthesia for these combined procedures.   They are both very safe and allows the surgeon to be a bit more aggressive during the liposuction portion.  
Best wishes 
Dr. Taranow

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