I have almost 6 months post op breast augmentation with silicone implants under the muscle and have been diagnosed with cc on my left side. I will need a revision and would like to know what type of anesthesia for this type of surgery would be safest. In my original I had IV sedation and would prefer this, but one of the surgeons that I am considering uses LMA and this sounds just like general to me. I do not want to go with general due to potential risks involved with it.
What is the Best Type of Anesthesia for Breast Revision
Doctor Answers 11
Anesthesia and Breast Revision Surgery?
Anesthesia for capsular contracture treatment
The "best" type of anesthetic for breast augmentation or revision procedures is that type of anesthetic that your chosen surgeon feels most comfortable with.
My own preference for capsulectomy is a deep IV sedation without inhalational general anesthesia. A great deal of time is spent at the beginning of the procedure putting the right amount of local anesthesia in the right place. This reduces the depth of anesthesia necessary. The advantages are a smooth wake-up, walking from the OR to recovery with very little discomfort, and less nausea.
Anesthesia for breast revision
The risks of modern anesthesia are very low. Indeed, you are safer in the O.R. than driving your car to the O.R. That being said, it is still something to be taken seriously. The main question is how extensive an operation do you need, and what is the best anesthetic technique for you? Have a good discussion with your plastic surgeon. If you want to speak with the anesthesiologist, that may be a good idea as well. Together, you will come up with a plan that works for you.
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Anesthesia for breast revision
The best anesthesia for breast revision.
Why do you think general anesthesia is "less safe" than IV sedation? Statistically speaking, IV sedation may require MORE medication than an uncomplicated general anesthesia, though I can attest (with over 21 years of experience in our accredited office surgical facility) that TIVA is better than inhalation general anesthesia. Claiming IV sedation is "safer" is what some surgeons who do not have general anesthesia capability may tell their patients, or one way they hope to reduce costs (especially in a redo). But "less safe" is not the issue (since BOTH are really, really safe). What is BEST is a much more critical issue!
See my article (on the About tab on my Profile page on this site) titled: "Is TIVA (Total IV Anesthesia) or General Anesthesia Safer?"
Your surgeon may have to do extensive surgical dissection to deal with the capsular contracture. This can be difficult and bloody, and having a wiggling patient (IV sedation) because of perceived pain does not help the situation. In fact, I would suggest it increases the risk of IV sedation overdosing, increases the risk of aspiration pneumonitis (with an uncontrolled airway), and ends up causing a more nauseated, and longer recovery, which in turn increases the risk of vomiting, increased bleeding and bruising, and recurrent capsular contracture. So be careful what you ask for!
I would suggest that any form of general anesthesia will allow your surgeon to concentrate on doing the most careful surgery possible, and offers you the highest likelihood of subsequent success, as compared to IV sedation. I personally would use TIVA with an LMA, and have over 16000 cases over 21 years without a death, heart attack, stroke (or aspiration). 8 patients required hospital transfer for evaluation of cardiac arrhythmia or other concerns (0.05%), all of which did well, and with even fewer overnight hospitalizations required.
All of the anesthetic regimens are safe; none is foolproof. Use what your chosen surgeon recommends!
Anesthesia for Breast asurgery
Both IV Sedation with Local and General anesthesia work exceptionally well. I have used both, but prefer General for a number of reasons. I and my Anesthesiologists believe it is the safest and I have had much less postopereative nausea with it, since you breath out the gases very quickly and the IV medications take 24-48 hours to metabolize. With this change in anesthesia and some other modifications in technique, most breast surgery patients are back to most normal activities in 24 hours or less.
Anesthesia for the release of a casular contracture
An IV sedation technique should work out fine as implants are easily placed and removed with this type of anesthesia. Capsular contracture can be difficult to treat and the recurrence rate is almost 50%. Be sure to discuss what happens if the implant is damaged and has to be released.
Best of luck,
Anesthesia for Capsular Contraction
The type of anesthesia right for any procedure should be discussed and decided between the patient and their surgeon. IV sedation with local anesthesia can be an acceptable approach, but keep in mind if the capsule is thick or adherent to surrounding tissues (muscles, skin) it may be difficult to have complete and effective anesthesia.
An LMA is a form of general anesthesia, although it is a less invasive method.
A consultation with your anesthesia provider might benefit you as well.
LMA general is best for you
To properly deal with a cc, the entire scar capsule needs either to be removed or at least substantially released depending on how bad it is. In my practice, this cannot be well done under any less than general anesthesia with an LMA airway. With a MD anesthesiologist in a healthy patient, this is a safe plan.