The PS I Saw Siad He Can Do Aug/lift Under Local, is This Safe Practice?

He states that PS performed under local is completley safe and adds less risk to the patient and cost, I would consider myself very tough, had all my children without epidurals or medication but am worried about the safety and recovery

Doctor Answers 16

Safe if performed by board certified plastic surgeon in an accredited facility

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I have been performing awake breast augmentation for over four years. I am one of the few Board Certified Plastic Surgeons by the American Board of Plastic Surgery that perform the procedure in my Medicare certified surgery center. You avoid the risks of anesthesia loss of control, the fear of not waking up, nausea/vomiting. The cons are there is some mild discomfort but very tolerable and you will feel a lot of pulling and tugging.

Unfortunately, most surgeons who do this are not board certified plastic surgeons and do not perform the procedure in a certified facility. By not having the proper certification and by not performing it in a Medicare certified surgery center they do not have privileges to perform the procedure in a hospital. This creates a higher risk of problems such as infection control etc. So it is important to find a surgeon who has the right credentials and performs it in the right facility.

Breast Enhancement

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If the doc is board certified and he or she is comfortable than this is likely ok, I prefer general anesthesia with a board certified anesthesiologist for comfort and safety

Breast Augmention Under Local Anesthesia?

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Local anesthesia without having an an anesthesiologist to provide sedation is a very bad idea.  It will not be a comfortable experience.  Do not try to "cut corners" for expense reasons.  This is a once-in-a lifetime operation - a real life changer.  Treat is as such.

Local anesthesia usually means intravenous "twilight" anesthesia with additional local anesthesia.  You have to make sure that an anesthesiologist is giving the sedation, not the surgeon.  He will be busy doing the surgery and it is risky if he tries to do both.

The good:

Less grogginess immediately after surgery.  This won't matter at all by the next morning.

The not as good:

It is technically more difficult to operate in the "twilight" mode.  You have to sit the patient upright near the end of the procedure to judge the shape and symmetry, and this is harder to do if the patient is only partially anesthetized.

Best of luck,


Dr. Diehl 

Gregory Diehl, MD, FACS
Long Island Plastic Surgeon

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Do NOT Do a Breast Augmentation and Lift Under ONLY Local Anesthesia

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Plain and simple, while this may be able to be performed, I would not recommend it. First off it is important to place implants under the muscle as this has been shown to reduce capsular contraction and therefore longevity of your implants and results!  It would be nearly impossible to place an implant under the muscle using only local anesthesia. Make sure your surgeon placed your implants under your muscle.  Sounds like your surgeon wants to cut corners for reducing cost and I am certain he is placing them over the muscle , going too big and probably performing an inadequate lift (probably just a Benelli or lift around the areola, which doesn't effectively lift the breast just repositions the nipple). Below is a video that explains a safe technique to go under the muscle with less than a 24 hour recovery in most patients.  However, no lift was done on this patient. Good luck and I would suggest you see a few more surgeons.

Ashkan Ghavami, MD
Beverly Hills Plastic Surgeon
4.1 out of 5 stars 105 reviews

Lift / aug under local

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Modern anesthesia is very safe, when administered by a board-certified anesthesiologist in an accredited facility.  While it is technically possible to do a breast augmentation under local, the vast majority of my patients don't want to feel it, hear it, smell it, or be aware during the operation - even for the smaller operations when I offer them a choice of anesthesia techniques.

That being said, I do this particular operation (aug/lift) with an anesthesiologist, who gives a light anesthetic.  The patients wake up quickly afterwards, and have a very pleasant experience.

Often those docs that tout the advantages of "local only" don't have an accredited facility, hospital privileges, or an check carefully.

Breast lift with implants under local anesthetic may not be the best idea.

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Yes, it is possible to have a breast lift with implants under local anesthetic, but that does not mean it is a good idea. The vast majority of plastic surgeons would not do this.

The bigger question is why is he offering this to you?  I know that some physicians who perform procedures in their office under local do so because they are not board-certified and cannot get privileges at accredited facilities to do plastic surgery.

Your surgeon may be board-certified but he may not be either. I recommend you go to the website and find out.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Breast Augmentation and Mastopexy under local anesthesia

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There is no question I would not perform these two procedures under local. I agree with my colleagues, just because it can be down, doesn't mean it should. In theory, any surgery can be done under local, I could cut off a leg under local, but why?  Please make sure your surgeon is a Board Certified Plastic Surgeon and is operating out of an accredited facility.  

Just because it can be done

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Just because it can be done doesn't mean it should be done that way. I can do surgery on a kitchen table, but wouldn't do it that way. Real board certified plastic surgeons do surgery safely in well controlled safe environments. Although I inject local when a do a mastopey with implants, I still have an Anesthesiologist present who will either sedate, or give a mild general to the patient, for their comfort and safety.

40 years ago, prior to the development of safe office anesthesia, people might have done this under straight local, not now.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Breast Augmentation/Lifting under Local Anesthesia?

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Thank you for the question.

No, I would not suggest that you have the breast augmentation/breast lift procedure done under local anesthesia. You will find that the majority of well experienced board certified plastic surgeons would not recommend this practice. I was suggest that you check the credentials of the surgeon who recommended this operation/type of anesthesia to you.

Best wishes.

Breast Augmentation under local

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The basic answer to your question is yes, a breast augmentation and lift can be performed under local anesthesia. The more important question is whether that is a good idea. If you place both the implant outside the muscle and tighten the skin at the same time, you risk having the implant erode out through your skin at a later point in time. Most plastic surgeons that will give an opinion on this site   recognize this is one of the highest areas of liability in plastic surgery, the combined procedure. I almost always place the implant under the muscle. I will frequently also tighten the skin somewhat at the same operation while getting the nipple areola in the right location. I always leave the lower skin a little bit loose and re-tighten it 3-6 months later in the office under local. Then  it is easy to tighten skin with the implant and the skin separated by healed tissue. I would recommend against doing this procedure under local anesthesia. Are you dealing with a board certified plastic surgeon?

David Janssen, MD, FACS
Oshkosh Plastic Surgeon
5.0 out of 5 stars 29 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.