Safe to Use Tumscent Local Anesthetic for Breast Implant Exchange?

I am a 50 year old woman and had a breast lift/implants 6 months ago. My right breast has now become incapsulated and I am having it taken out along with scar tissue and a new implant put in. The Doctor says it will only take 30 to 45 minutes and that it is safe, but I have read that it could also be dangerous. I don't want to go back under G.A. because I felt horrible for days afterwards. Is it safe to have this procedure done using this type of local?

Doctor Answers 13

Local Vs General Anesthetic For Capsule Removal

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It sounds like you need a complete or near-complete capsulectomy. This can and often is a fairly complicated procedure. I would caution you about a straight local anesthetic and believe that a tumescent technique will probably distort the planes of dissection. Another thing to consider is that thick capsules may result in significant amounts of tissue removal which may require an increase in implant volume to maintain symmetry. The extra fluid from the tumescence will make it difficult to determine how much the implant may need to be increased. All procedures using an anesthetic should be perfomed in a fully-accredited facility.

Minneapolis Plastic Surgeon
4.8 out of 5 stars 178 reviews

Local anesthesia for implant surgery is not a good idea

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Every surgeon has his or her own opinion, but general anesthesia is probably a better choice for the type of surgery you are considering. If there is a capsular contracture, the surgery to remove the capsule can be difficult, and in order for your surgeon to be thorogh you don't want to take any short cuts. If the surgery is done in an accredited surgical facility, your experience and safety with general anesthesia should be better than trying to do it under local (even with tumescent.)

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Breast Implant Revision under Local Anesthesia

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Hi Clermont,

In a word - no.

Not in my opinion, anyway.  Although it may wind up not being THAT complicated a procedure, everything is relative and I feel that a procedure such as this actually is fairly complicated.  Furthermore, it can be difficult to achieve good local anesthesia in the presence of scar tissue (the capsule).  Finally, there is always the risk that you would have bleeding or some other problem that could extend the duration and scope of your procedure.

You don't necessarily need general anesthesia, but you need more than just local.  Local anesthesia in association with intravenous sedation is an extremely effective combination and many, if not most, procedures can be performed in this manner.  But local anesthesia alone, without sedation?

Probably not a good idea...

Sorry about that, but I hope that this helps, and good luck,

Dr. E

Implant revision with sedation

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If there is significant contracture, the best treatment involves complete (or near complete) removal of the capsule.  This certainly does not require general anesthesia.  Local anesthesia can go a long way for this kind of thing but I generally recommend at least a little sedation.  

Dr. York Yates - Utah

York Jay Yates, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 189 reviews

Tumescent anesthesia for capsulotomy/capsulectomy

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I think this is a bad idea.  Invariably there is much more work than expected when you remove the scar tissue.  It is difficult when the implants are under the breast tissue and near impossible when under the muscle.  Make sure you are having an anesthesiologist present or at least a nurse anesthetist to give you medication for pain control.  I would seriously think twice about tumescent anesthesia for this procedure!  Let us know how you do.

The safest option would be General anesthesia

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You have a problem with one breast and the reason is too much scar formation and inflammation. The surgery is involved and will require release and removal of the contracted capsule. The tumescent will cause tissue distortion and will make it hard to adjust the implant position during the surgery. The surgery should be done in a certified surgery center and under general anesthesia or IV sedation with general anesthesia as a back up.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 154 reviews

It is safe

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It is safe to have this procedure done with local anesthetic - but you would be more comfortable if you have iv sedation along with it ("twilight sleep").  This type of anesthesia is easier to recover from and you won't remember anything from the surgery.  Good luck!

Tumescent solution for breast revision

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As long as extensive dissection is not required, tumescent solution infiltration for minor breast replacement and small area of capusle excision may be tolerated. You should still have an anesthesiologist present to monitor you during your surgery.

Arian Mowlavi, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 108 reviews

Removing Scarred In Breast Implant Under Local Anesthesia

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In the operation you are about to have, the surgeon has to carefully peel the scarred in breast implant and the scar from the adjacent breast tissue and chest wall. Each case is different, but there is bleeding involved which needs to be carefully stopped. The peeling off the breast on the top and off the chest wall on the bottom CAN be associated with several complications related to thinned tissues and invisibility (such as removal of some breast tissue, making the pocket too large and worse of all, entry into the chest (Pneumothorax) which is best treated if recognized immediately.

Is such surgery "POSSIBLE" under tumescent local infusion? Yes, it is possible. It can even be made more comfortable with intravenous sedation. Is is "SAFE" to do it this way? Personally, I would not do it this way on a close friend or family member and therefore prefer not to do it on people who trusted me enough to come to me - my patients. The BEST way to do the procedure is under general anesthesia which gives the surgeon the best visibility and the patient the best control of the airway and vital signs. The ONLY reason to do it with tumescent solution is because it may be cheaper or the patient insists.

Your past experience with anesthesia is not common. Ask for a different anesthesiologist (Hint - ask for the one the nurses and doctors use for their families), make sure he/she knows of your past experience and you will do great.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon

Implant Exchange Can Be Done Under Local

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I feel that it is safe for you to have your implant exchange and capsulectomy performed under local anesthesia.  I would not use tumescence, however, as this would greatly increase local swelling without adding any anesthesia.  I would recommend that the local be accompanied by intravenous sedation given by an anesthesiologist or CRNA.

John Whitt, MD (retired)
Louisville Plastic Surgeon

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.