Mia Femtech and sedation

Question

Good afternoon, I would like to ask if sedation is necessary for mia procedure if the patient does not want to take a pill or have sedation injected into a vein, is it still possible to perform such a procedure on patient? I understand that for some patients this procedure is stressful, but for me the fact that I have to take sedation (mainly benzodiazepines) is more stressful. The discomfort in the form of pain during the procedure is less stressful for me than taking medication. Is there a doctor who would be able to perform the procedure under local anesthesia only without sedation? I am interested in this procedure but I do not want to use sedation, I want to be conscious. I also donot use sedation for gastroscopy and minor surgical procedures.

Daniel Barrett, MD · Answer

Dear samiramoe,

it is hard to tell for sure without an examination. If you are considering a procedure, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.

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

Using the axillary incision will be more painful in positioning the implant. If your incision is placed beneath the breast or around the areola, the augmentation could be done under local if your implant is not too large.

Mats Hagstrom, MD (license on probation) · Answer

The MIA is a sub glandular breast augmentation procedure. What makes a difference is the unique expander device and filling device.
Otherwise, it’s more or less just a breast augmentation.
The same type of procedure can be done using other equipment.
There are inherent limitations with minimally, invasive breast, augmentation surgery.
The surgeon has much less ability to control the shape of the implant pocket.
This becomes much more important if larger implants are used.
Likewise, the procedure is primarily designed for implants above the pectoralis muscle, and there are substantial advantages to placing implants under the pectoralis muscle.
Personally, I believe if you’re going to do breast implant surgery, then it should probably be done correctly.
This means generally putting the patient to sleep making a proper pocket under observation which requires making a larger incision.
Finally placing the implant in a sub pectoral  position.
The form of anesthesia is up to each provider.
Almost all surgical procedures can potentially be done using only local anesthesia.
The amount of potential discomfort is than related to the surgeons skill of injecting, local anesthesia, and the procedure performed.
 Some tissues are easier to anesthetize than others.
Mostly this has to do with the surgeons ability to work properly with local anesthesia and having done the procedure this way previously.
If the surgeon has excellent local anesthesia skills and experience doing the procedure with no or minimal sedation then the procedure is definitely possible that way.
 If the surgeon relies heavily on sedation and not local anesthesia, then most likely the procedure if done using only local can be painful, and this can slow down or even inhibit completing the procedure.
Trying to decipher which plastic surgeon has the skill and experience to do this operation using no sedation is going to be difficult.
Most plastic surgeons are pretty set in their ways.
You may want to consider looking for plastic surgeons who have a lot of experience doing the surgery with patients awake like those who do a lot of awake Liposuction.
 Surgeons who can do major body contouring without general anesthesia are most likely gonna have excellent skills using local anesthesia. 
I suppose your best option is to simply start consulting with providers to see what they have to say.
You may think you can tolerate surgical pain until you’re on the table and you can’t. It’s not a good idea to go into surgery with uncertainty if it can be avoided.
Generally, if we’re going to start something, we wanna make sure we can finish it.
A potential undesirable scenario is starting the procedure but not being able to finish.
Another option is to have the patient consented and agreed to receive sedation if the procedure becomes too painful.
Unwillingness to go along with the recommended approach may be a good reason to consider not having the procedure.
Personally, I would refrain from telling doctors how to do their job.
We do things for a reason.
Ultimately provider selection is the most important variable for a number of reasons not just the type of anesthesia.
Best,
Mats Hagstrom MD

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