Twilight IV Sed or General Anesthesia for BREAST IMPLANTS under the muscle! What are the risks and benefits?

So I finally decided the doctor I'm going with. Now I'm wondering if I should do IV Sed or General. My concerns with general is that I will be receiving general for a dental procedure this month and I'm planning on sched my surgery for late sept or Oct and I'm concerned is this too close for having two procedures within 60-90 days of each other. Also I'm scared to be put under but I guess I'll be facing my fears in the oral procedure before hand. $$ is not my biggest concern my safety/comfort is

Doctor Answers 16

Anesthesia for Breast Augmentation Under the Muscle?

As you can see here, most surgeons recommend a general anesthetic for breast augmentation, particularly when it is under the muscle. It is much more painful to create an implant pocket under the muscle and it can  be very difficult to get you comfortable with just IV sedation. In addition, your muscle will be more relaxed  which will make it easier for your surgeon to do the necessary dissection, and a general anesthetic delivered by a board certified anesthesiologist is much safer than IV sedation directed by the surgeon. There is no issue with the two anesthetics being 60-90 days apart.

Kirkland Plastic Surgeon
4.8 out of 5 stars 53 reviews

Augmentation under IV sedation

is very doable and how I used to do this procedure for many years... but when under general anesthesia, the procedure was just a little easier so I no longer do them with IV sedation.  But patients who have had it done that way had no recall of any discomfort.  It does take a little longer since additional local must be injected as needed but its very doable.  As for fears of having anesthetics too close to each other, I am not aware of any additional risks it may create.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews


Many Plastic Surgeons prefer GA to IV sedation. You will not necessarily be more comfortable or safer with IV sedation. I recommend that you discuss your Plastic Surgeon's preferences, credentials, anaesthesiologist, facilities, etc. and ensure that your concerns are addressed.
All the best

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

Twilight IV Sed or General Anesthesia for Breast Implants under the muscle?

In most cases, I would would suggest general anesthesia for sub-muscular breast augmentation.  It is difficult to achieve excellent anesthesia with sedation and local anesthesia, for this type of procedure.  Having an anesthesiologist present will also decrease risks.  In this case, the added cost will be well worth while.  Best wishes, Dr. Lepore.

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.8 out of 5 stars 56 reviews

IV sedation or general anesthesia for breast augmentation under the muscle.

Both IV sedation and general anesthesia are safe. I personally prefer  IV sedation and tumescent local anesthesia since 1996. Never had any patient complain of pain, being aware of the surgery or have more pain postop. Matter of fact, due to the local tumescent solution anesthesia under the muscle, the dissection is extremely dry and the patient has minimal discomfort for the first 6-8 hours. Also, the risk of nausea and vomiting is nonexistent with my technique. This is an operation where the surgeon's delicate handling of the tissues and precise dissection is of utmost importance to achieve natural long term results. Good luck with your surgery. Choose your surgeon based on results and being there for you. Trust his/ her judgement on choosing the type of anesthesia that they are comfortable working with.

George Marosan, MD
Bellevue Plastic Surgeon
4.8 out of 5 stars 38 reviews

General or IV Sed for breast implants?

In my opinion, general anesthesia is ideal for breast augmentation especially under the muscle.  With general your doctor can provide some amount of muscle relaxation while you have a secure/safe airway.  It is not safer to perform cases under Twilight as many people believe.  Having a safe secure airway under proper monitoring is the most important factor.  As others have stated, however, make sure both docs know what and when the other is performing surgery so proper scheduling can happen.Best wishes and good luck.

Shayne Webb, MD
Nashville Plastic Surgeon
5.0 out of 5 stars 47 reviews

Safety and Comfort

Hello,Given your preference for safety and comfort, I recommend general anesthesia by a ABA certified anesthesiologist in a AAAA, AAA, or Medicare certified ambulatory surgery center.  ABPS certified/ASAPS member surgeons only operate in facilities like this and are the best plastic surgeons to perform your breast augmentation. History has proven that IV sedation is more dangerous, with a higher risk of death than properly monitored and delivered general anesthesia. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 89 reviews

Sedation vs. General anesthesia

Thank you for your question. Either way you should be attended by a trained anesthesiologist. General anesthesia is very safe and is my personal preference for BA surgery. I feel it provides the most comfort for the patient and ease of operation for the surgeon. Also, be sure to check the credentials of your surgeon, anesthesiologist, and facility where the operation is being performed (board certification, etc). Best of luck, Dr. Kludt

Nathan Kludt, MD
Stockton Plastic Surgeon
4.9 out of 5 stars 28 reviews

General anesthesia

I prefer general anesthesia on all my patients undergoing Submuscular implants. It is the safest approach and should be performed with board certified anesthesiologist 

Stuart A. Linder, MD, FACS
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 42 reviews

Keep your doctors in the loop.

Hi bayblackbarbie, There really is no set waiting period between anesthetics, however you need to let both physicians (your plastic surgeon and your dental surgeon) know your plans to have both surgeries and make sure they speak with their respective anesthesiologists so they too are in the loop. They will tell you if based on your health history or their professional opinion, you should wait longer between procedures or change anesthesia types. General anesthesia is the preferred method for most board certified plastic surgeons. Not only are you asleep, your muscles are too! This allows us to perform a submuscular breast augmentation easily, efficiently and safely. In my opinion, the benefits of this type of anesthesia far outweigh the very small risks. Talk to your surgeons! Good luck!

William Aiello, MD
Orange County Plastic Surgeon
4.9 out of 5 stars 48 reviews

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.