Requesting an anesthesiologist instead of CRNA, requesting different kind of anesthesia?

My Institute for Medical Quality (IMQ) accredited surgery center contracts with independent board certified anesthesiologists, but this will differ with different offices.  If your PS is unable to accommodate your request for a board certified anesthesiologist, consult with another PS who performs hundreds of breast procedures annually with great results and favorable patient reviews.Removal of the implant can be performed under local anesthesia, but capsulectomy would require a greater level of anesthesia. 

Thanks for writing,I would certainly discuss this with your Board Certified Plastic Surgeon. I will say that I work with both, CRNA's and MD's and both can deliver fantastic care. CRNA are typically supervised by and MD, in our OR's an MD is always there. General Anesthesia has become so good now, and if your healthy, you should do very well and have an excellent experience. The GA's also allow us to work comfortably know you are not uncomfortable or antsy. Good Luck, I hope this helps.Stephen M. Davis, MD, FACSBoard Certified Plastic SurgeonMember: American Society for Aesthetic Plastic SurgeryMember: American Society of Plastic Surgeons

There is a big difference in training between a CRNA and an MD (anesthesiologist).  They generally work as a team in hospital settings and sometimes in surgery center settings.  It is great that the center is accredited by AAAASF.  If there is no anesthesiologist there then the surgeon is responsible for supervising the nurse anesthetist.   In my AAAASF facility, I have only MD anesthesiologists as I do not feel I am trained to supervise a nurse anesthetist.   In the hospital, I love working with the nurse anesthetists but there is a physician anesthesiologist in charge and supervising.  If you desire and MD that is certainly reasonable so seek a setting where that will be the case.  Best wishes!

I encourage you to discuss your concerns with your surgeon.  CRNA's work under an anesthesiologist to ensure quality care.  Typically general anesthesia is used for the procedure you described.  You may also request to speak to the anesthesiologist to discuss your concerns.  Many times after hearing what all is involved in keeping you safe during surgery from an anesthesia perspective, many patients feel more secure going forward.

Discuss with your plastic surgeon the options for anesthesia including using a CRNA or a board certified anesthesiologist.  It may be beneficial to obtain several consultations from plastic surgeons in your area if your surgeon cannot provide an anesthesiologist as you requested. I prefer to work a board certified anesthesiologist who provides general anesthesia during surgery.  Best wishes. 

Hi and welcome to our forum!
In our state, we often use the services of a CRNA to provide anesthesia for our healthy patients. There is always a board certified anesthesiologist available in the facility. We have never encountered a problem. In fact, our CRNA previously worked in a trauma unit and has considerable anesthesia experience under difficult circumstances. If a patient specifically requests a board certified anesthesiologist, we provide one to them. 
As far as choice of anesthesia, it depends upon the severity of the capsule. One cannot ask a surgeon to work out of his / her comfort zone.  Under a general anesthetic, even complicated capsulectomies can be performed without difficulty. One can be more thorough in this circumstance.
If you are not satisfied with the recommendations of your plastic surgeon, you may seek a second opinion. If your second opinion physician agrees with your plastic surgeon, you will have the answer!
Best wishes...

It is important that you feel comfortable prior to proceeding.  Therefore, you should make the request;  hopefully your plastic surgeon will be able to comply. Otherwise, you may wish to seek additional consultations…

  In regards to the type of anesthesia, practices will vary. In my practice, I prefer the use of general anesthesia supervised by a board-certified anesthesiologist when performing the type of revision to breast surgery you are planning.  I believe that this type of anesthesia provides for a comfortable/safe/immobile environment to  perform the procedure. 

 Best wishes.

Dear XOXO1982,Hello and thank you for your excellent question. We routinely perform breast implant removal (alone) under local anesthesia, but it sounds like your surgery may be more involved than that (if you are having a capsulectomy etc). It is not unusual to request an MD anesthesiologist. If you want this, then ask your surgeon. However, be prepared that if this is not offered, then you may need to switch surgeons or seek a second opinion.On a separate note, what will you do when the implants are removed? You should be evaluated for a No-Vertical-Scar, No-Implant breast lift technique. There are a number of no-vertical scar breast lift techniques, but my preferred technique is the Bellesoma Breast Lift technique. Our technique provides an exceptional breast lift, upper pole fullness, relief from neck and back pain, and no vertical breast lift scar. It uses a woman’s OWN breast tissue to produce an internal suspension technique, without the need for a breast implant. It does not disturb the nipple, areola, or breast glands, so sensation and the ability to lactate is preserved. It uses 3D scanning of your breasts and body to design a procedure specifically designed for YOU, and you alone. Finally, for patients who desire breast enlargement, it can be combined with fat grafting. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!

Best,

Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Texas “Top Doc” 2017, 2018

RealSelf100

America’s Top Plastic Surgeons, Consumer’s Research Council, 2010 – 2018

BeautyAdvisor Top Contributor

 In my practice, I prefer the use of general anesthesia supervised by a board-certified anesthesiologist when performing the type of revision to breast surgery.  CRNA's also work with the anesthesiologist in most cases. Discuss all your options with your surgeon and the anesthesia department.