Awake breast augmentation.

I do not want to be placed under during my procedure, I am afraid and I don't want to wake up with the sore throat from having a breathing tube in my trach. How long does a simple breast enhancement through the breast fold and over the muscle take? What are the actual risks being awake or is it the same as being put under.

Doctor Answers 21

Awake breast augmentation

a fully awake breast augmentation is not typically done and is not desirable. I perform breast augmentation under IV sedation administered by an anesthesiologist with local anesthetic nerve blocks. There is no tube in the throat and the surgery is much more controlled than attempting this while awake. 

Sincerely,

Thomas C. Wiener, MD

this information is not a substitute for a consultation by a board certified plastic surgeon.

Awake breast augmentation

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a fully awake breast augmentation is not typically done and is not desirable. I perform breast augmentation under IV sedation administered by an anesthesiologist with local anesthetic nerve blocks. There is no tube in the throat and the surgery is much more controlled than attempting this while awake. 

Sincerely,

Thomas C. Wiener, MD

this information is not a substitute for a consultation by a board certified plastic surgeon.

General Anesthesia During a Breast Augmentation

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.

General Anesthesia During a Breast Augmentation

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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.

Awake breast augmentation.

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.


Awake breast augmentation.

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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

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

IV sedation breast augmentation

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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

Anesthesia and elective cosmetic surgery

There are 3 basic types of anesthesia for elective cosmetic surgery:

  1. Local anesthesia (wide awake)
  2. Local with sedation (awake but groggy)
  3. 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!

Anesthesia and elective cosmetic surgery

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There are 3 basic types of anesthesia for elective cosmetic surgery:

  1. Local anesthesia (wide awake)
  2. Local with sedation (awake but groggy)
  3. 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!

Awake breast augmentation.

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, 

Awake breast augmentation.

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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, 

Awake breast augmentation is it a good idea?

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!

Awake breast augmentation is it a good idea?

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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!

Awake breast augmentation.

I occasionally have a patient ask if they can have a breast augmentation without a general anesthesia and my answer is always "Yes, but not in our office". In years past, before the improvement of general anesthesia I did all augments with local and a light sedation. After 1990 I have done all augments with a general. I can tell you the patient satisfaction rate is huge. We use a tube that does not give sore throats and always use board certified anesthesiologists. 

Awake breast augmentation.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I occasionally have a patient ask if they can have a breast augmentation without a general anesthesia and my answer is always "Yes, but not in our office". In years past, before the improvement of general anesthesia I did all augments with local and a light sedation. After 1990 I have done all augments with a general. I can tell you the patient satisfaction rate is huge. We use a tube that does not give sore throats and always use board certified anesthesiologists. 

Awake breast augmentation.

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. 

Gurmander Singh Kohli, MD, FACS
Fall River Plastic Surgeon
5.0 out of 5 stars 3 reviews

Awake breast augmentation.

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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. 

Gurmander Singh Kohli, MD, FACS
Fall River Plastic Surgeon

Twilight or Local Anesthesia

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.

Twilight or Local Anesthesia

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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.

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.