Risks of Twilight Sedation for Breast Lift and Augmentation?

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.

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.

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.

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).

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.

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.

I'm also a proponent of general anesthesia...not because it can't be done under sedation, its just much more patient dependent and the chance of inadaquate anesthesia is higher than it would be with general.
The point I wanted to add was to be sure its not THE SURGEON giving the anesthesia. Unfortunately, some docs recommend sedation to cut corners. They give the anesthesia AND do the surgery. Obviously, you can't keep track of both at the same time and, even with a nurse helping you, its not the safe way to go. Insist on a licensed, board certified anesthesia provider.

Local Anesthesia with Sedation, or Twilight anesthesia, is a very effective and safe way to perform Breast Enhancement procedures. In fact, 95% of my patients undergoing breast augmentation with implants choose twilight sedation and respond afterward that the experience was not that discomforting. For most of my patients it comes down to the fear of "going under" anesthesia, recovery time, nausea effects afterward, and cost.
The patient is given an IV sedative to relax them, then I perform local anesthetic nerve blocks under the ribs (where the nerves arise) and the breast tissue itself to achieve anesthesia of the chest and breasts. The nurse can deliver more medication for pain and sedation as necessary during the procedure while still monitoring vital signs. Implants can be placed above or below the muscle, and simple breast lifts can be performed as well. The only patients I feel need a general anesthetic are those with prior breast implants who need a removal/replacement or formal breast reduction/lift.
Local anesthesia with sedation is safe, easily performed, less costly and well tolerated for straight forward breast enhancement procedures.

Twilight sedation is commonly done for patients who can not have general anesthesia or at centers who do not have accreditation. In almost all cases, general anesthesia is the safer and more comfortable option.

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.