Can I be awake during breast augmentation?

I have performed the procedure under local once or twice and do not prefer it at all. I think it is actually more difficult that way.  It is nearly impossible to adequately place the implant under the muscle because of the lack of muscle relaxation you can get with general anesthesia. If you are given sedation, the anesthetist must monitor you on a  breath by breath basis, to be sure you are not building up carbon dioxide or not getting enough oxygen in your blood. LMA is a nice option I commonly use, and the risk of a sore throat is low using this technique.

Thank you very much for your question. Breast
augmentation procedures are almost always performed using general anesthesia.
As this is an invasive procedure, general anesthesia ensures your comfort and
safety during surgery. Overall, breast augmentation and general anesthesia are
generally safe. As long as you are using an experienced, trusted surgeon, the
chance of post-op complications is small. My recommendation is that you
schedule a consultation with a board certified plastic surgeon in your area,
who can explain the breast augmentation process in detail. You may also be able
to consult with a board certified anesthesiologist who will be working with
your surgeon.

Thank you for your question. In theory an awake breast augmentation can be done.  We perform all our breast augmentations under GA for the best interest of the patient. You will have to speak with a surgeon who is willing to perform a local breast augmentation. Best, 

Unfortunately the best results with the least amount of risks occur with a tube and general anesthesia. Talk to your board certified plastic surgeon and they should be able to steer you in the right direction.Good luck!

I appreciate your question

After performing hundreds of breast augmentations, I have found that the size of implant best for you is dictated by your chest wall measurements. Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision. Bringing photos as well can help us to finalize, but please understand that these are of other peoples bodies and your results will probably be different.

Silicone will give you a fullness at the top (upper pole fullness). Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more softer silicone (less cross-linked), if this implant should rupture, it may leak but only into the scar capsule formed. However, the newer silicone in these implants may not leak even when the implant shell is ruptured. 

Anatomic gummy bear implants might be a good choice to give you a more natural look. These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.

During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers. I also use a 3D imaging system to allow you to try on a variety of shapes and sizes. I prefer this method over adding volume due to implants being under the muscle.

We will also discuss the possibility of needing a lift along with an implant. This will depend on the amount of ptosis (nipple position) as it relates to your breast, inframammary crease and chest wall. Needing a lift or not will also determine where to place the scar for the incision.  In some cases if the the breast and nipple is really ptotic (low) it might be best to stage the procedure by performing a lift first and then doing an implant at a second stage. This will also allow you to have a better understanding of the true size and shape of your breast.This could be done "awake" but then it makes it very difficult  to place the implant under the muscle and you risk  higher complication rate such as bleeding. If you want implants placed above the muscle this could be a better option.

The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

best of luck!

Dr Schwartz

Board Certified Plastic Surgeon 

#RealSelf100Surgeon

#RealSelfCORESurgeon

Breast augmentation is safe and is done under general anesthesia in the vast majority of cases in the US. There are good reasons for this fact and safety is one of those reasons. Speak with your plastic surgeon, but I don't believe you will benefit from being awake, in terms of getting a good long-term result. I do not use tracheal tubes, but a laryngeal mask and the operation is less than 1 hour routinely. Best wishes, Dr. ALDO

I've done this procedure for a number of years, as there are some patients that simply prefer to avoid any type of general anesthesia, general or LMA. I will say that LMA is probably the best technique as there is no tube placed in the trachea and patients breath on their own, avoiding the problems you mention.Nevertheless, for patients who do not want any type of general or LMA anesthesia, the procedure can be done with IV sedation, rib blocks and some additional local anesthetic. I prefer to have an anesthesia person on standby - never can be too safe. The technique takes a few minutes longer than the others but patients have minimal pain and can leave recovery more quickly. The procedure normally takes about an hour. The risks are the same as with any anesthetic but the awake technique does carry a slight risk of complications due to the the rib blocks.

IV sedation breast augmentation is my preferred form of anesthesia for breast augmentation. The benefits include, quicker discharge from recovery, no sore throat and less postoperative nausea and vomiting compared to traditional endotracheal anesthesia with general. This procedure typically takes 45 minutes to 1 hour to perform. It is best to be seen by a board certified plastic surgeon who performs many breast procedures in conjunction with an anesthesiologist that is comfortable with IV sedation.Best wishes,Dr. Ravi Somayazula

There are 3 basic types of anesthesia for elective cosmetic surgery:Local anesthesia (wide awake)Local with sedation (awake but groggy)General anesthesia (totally asleep)With breast augmentation any of the 3 can be performed, but the vast majority (99%) will be either #2 or #3 above.  There are some surgeons in Israel who are performing wide awake breast surgery with nerve blocks in the back to numb the breasts during surgery, but there is also the danger of complications from that type of block (punctured lung, respiratory depression, prolonged numbness).In any case, you will need a board certified anesthesia person at the head of the table to monitor vital signs, administer pain medication and control the airway, even under a local anesthetic.  So, there is no cost advantage with only a local anesthetic.  If you are nervous about the surgery, then the last thing you want to do is be awake for the surgery.  You will hear and feel everything, you will be cold and have to hold still, even when it hurts.  When I have a nervous patient, the best advice I can give them is to go to sleep for the surgery.  You close your eyes and when you open them it is over.  This is an extremely safe procedure, much safer than even driving your car to the office for your surgery!  The anesthesia personnel can use an airway device (LMA) that does not go down your larynx, so no sore throat, and your recovery will actually be quicker.Good Luck!

Thank you for writing to RealSelf.Augmentation Mammoplasty can be performed under local anesthesia. You will feel the initial needles used to inject the numbing solution. When local anesthetic is used to block the intercostal nerves there is a risk of causing collapse of the lungs. Performing the procedure under local anesthesia is not the same as performing it under general anesthesia as the surgeon may be limited in what they need to do on account of the discomfort experienced by the patient. Instead of the tube in the trachea a laryngeal mask can be used and this will obviate the sore throat. In a healthy patient general anesthesia can be administered in a manner that the problems associated with it can be reduced very considerably to a degree that the experience is safe and pleasant.