Risks of Twilight Sedation for Breast Lift and Augmentation?

I'm a healthy 27 year old. I've been to a consultation with a local Dr. and I'm considering a Breast lift/Breast implants. However, I want to eliminate as many risks as possible. Is twilight "safer" than general? What are the risks of twilight sedation during this procedure?

And, can you please recommend someone in Mississippi, TN, or TX who does this procedure and is a Board Certified Plastic Surgeon? I'm having a difficult time finding a qualified Surgeon who uses twilight sedation. Thank you in advance for your help!

Doctor Answers 16

Risks of Breast Lift

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All surgical procedures carry some degree of risk. Any breast operation can result in changes in sensation. This happens less with lifts than reductions but is still possible Occasionally, minor complications occur and do not affect the surgical outcome. Major complications associated with this procedure are rare. The suitability of the breast lift procedure and specific risks may be determined during you consultation. Note that either type of anesthesia can work comfortably for your procedure, and this can also be decided upon when discussing with your PS.

Over time, gravity will continue to have an effect and the breast skin will tend to stretch. The degree of #stretching and #sagging varies between women: generally, women with smaller breasts experience less recurring sagging. If sagging does occur, further excision of the skin on an outpatient basis can be used to correct the problem. Heavy and large breasts may lead to recurrent sagging and may require the removal of a small amount of breast tissue to achieve an optimal shape and size. One key to a satisfying result is realistic expectations.

Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

General anesthesia versus IV sedation

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Thank you for your question. Both types of anesthesia can provide a safe and comfortable platform for breast augmentation surgery. It is more important that you feel comfortable with your surgeon and the surgical plan as this is ultimately what you will be remembering after the procedure.

Anesthesia-- Advantages and Disadvantages of Twilight

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It’s possible to perform combination breast augmentation, breast lift surgery utilizing either IV sedation or general anesthesia.Each approach has advantages and disadvantages and both approaches have advocates.

It’s important that anesthesia be administered by a board certified anesthesiologist irregardless of the type of anesthesia utilized.This is an important point because IV sedation is occasionally administered without an anesthesiologist as a cost cutting maneuver.When this happens, your surgeon is also your anesthesiologist.

I generally prefer general anesthesia for a variety of reasons.I typically place implants beneath the muscle and feel that general anesthesia makes the experience more comfortable for my patients.With newer anesthetic agents, patients tend to recover quickly with less nausea and fewer side effects.

It’s important to discuss these issues with your plastic surgeon before proceeding with surgery.It’s important that both of you are comfortable with the choice of anesthesia.In some cases, it might also be helpful to meet with the anesthesiologist before proceeding with surgery.

Breast Lifting and Type of Anesthesia?http://youtu.be/HGkTDGPjJzE

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Thank you for the question.
There is absolutely no evidence that “twilight sedation” is safer or provides for a better experience/outcome for patients undergoing plastic surgical procedures. In my practice I prefer the use of general anesthesia provided by board-certified plastic surgeon  who knows my routine well.
In regards to finding a plastic surgeon in your area, I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons.

Then, I would suggest you visit a few surgeons whose practices  concentrate on aesthetic surgery. Ask  to see lots of examples of their work and preferably speak/see patients who have had similar procedures done.

You will find,  while doing your due diligence,  that there are many different “specialties” who will offer their services to you;  again, I strongly recommend you concentrate on surgeons certified by the American Board of Plastic Surgery.  
I hope this helps.

Twilight vs. General

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I recommend that you focus on the anesthesia provider rather than the type of anesthesia. I insist on a board certified M.D. anesthesiologist to provide my patients' anesthesia care. Most of my patients undergo breast lift/implant surgery under LMA (laryngeal mask airway) anesthesia, but depending on their history, anatomy, etc., the anesthesiologist may recommend endotracheal intubation or a lighter form of anesthesia called MAC (monitored anesthesia care).

Breast lift with implants using twilight sedation

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There are many ways to perform a breast lift with implants. Patients that receive twilight sedation will not be aware of their surroundings and will not be completely asleep. It is important to ensure that your board-certified plastic surgeon has a great deal of experience performing this procedure with this type of anesthesia. The anesthesiologist must be very vigilant to make sure that you are comfortable but that you do not experience pain. The portion of the procedure that will create the most discomfort is the elevation of the muscle and the placement of the implant. If you choose to proceed with this level of anesthesia, be sure that the facility you are using has board-certified anesthesiologists who are ready to administer general anesthesia is necessary.

Board Certified Anesthesiologist very important for breast lift with breast implants.

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Both twilight anesthesia and general anesthesia are very safe and equally safe for breast lift with breast implants.  The important question is WHO is giving you the anesthesia.  Also make sure you are done in an ACCREDITED operating room.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Type of Anesthesia

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Twilight anesthesia may not be safer than general anesthesia especially if you are going to be under for a while, as you will be for a breast augmentation and breast lift. So I would be very carefull in regards to this. As long as you are healthy and have no medical problems that you may be ok for general anesthesia.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 88 reviews

BAM: Do you really want your plastic surgeon to be your anesthesiologist?

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There are many issues here:
1) Some people believe twiligtht is safer.
This is not necessarily the case.
2) Some believe it is less expensive
Only if your surgeon is the anesthesiologist and do you want him or her to worry about the heart rate, oxygenation, and blood pressure while giving you anesthesia or do you want him/her to focus on your surgery
3) Is your implant under or over the muscle.
If under the muscle, it may be difficult to adequately anesthetise the area especially while inflating the implant and stretching the muscle. This may involve injecting close to the ribs.
If the implant is to be placed over the muscle, it is possible to deliver local anesthetic under IV sedations
4) In any instance make sure you have a certified anesthesiologist delvier your anesthesia
The risks of twilight essentially include nearly all the same risks as a general anesthetic.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Go with a general anesthesia by a physician anesthesiologist

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A twilight sedation for a breast augmentation is usually supplemented by nerve blocks with local anesthesia. I am aware of a situation where these were done and punctured the lungs causing serious complications. Under a light general by a physician anesthesiologist, these nerve injections are not necessary and this risk is eliminated.

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.