Is it possible to do a breast reduction under twilight?

Hi and thanks for your question.  Although it would be technically possible to perform a breast reduction without general anesthesia I think the risks would outweigh the benefits.  First, a word about "anesthesia awareness" -- this is not something to worry about, as it does not happen under general anesthesia.  The reason some patients report this phenomenon is that it stems from their awareness as they awaken from anesthesia at the conclusion of the procedure.  During this time there is still a lot of noise and movement in the room (including taking the drapes down) and this awareness is commonly confused with being awake during surgery.  Fortunately that is not actually the case, the awareness is rather from after the surgery is over but the patient hasn't yet left the operating room.
Regarding twilight for a breast reduction, I see two problems.  First, you may actually become aware during surgery (just what you're trying to avoid).  Second, under twilight the surgeon would need to inject more local anesthesia into the tissues so that the surgery can be performed without pain.  However, injecting this anesthesia may be a painful process, and furthermore, there are toxicity levels to consider with injecting too much.  So although performing a breast reduction under twilight is definitely possible, I think it would be a much more uncomfortable experience.  
A visit to a plastic surgeon's office will help you to understand if you're a candidate for the procedure, and what aesthetic outcomes are realistic in your particular case.  In order to get a qualified, ethical, and expert opinion on your surgical options and expectations, always schedule an in-person office consultation with a plastic surgeon certified by the American Board of Plastic Surgery.
Best of luck,
Keith M. Blechman, MD
New York, NY

Thank you for the detailed question. With the right patient, it is possible to do a breast reduction under twilight anesthesia. Seeing a board-certified plastic surgeon in-person so that they can examine you and create a treatment plan that is customized to you and your needs would be the next best step. For more information please visit our webpage. 

It is possible to perform the procedure under twilight if that is in your best interests. You should express your concerns to both your surgeon and your anesthesiologist to determine if twilight is viable in your case. 

It's possible to have the surgery done under twilight, if you're a good candidate, but your surgeon and your anesthesiologist should be comfortable with it as well.

I trained in New York under awesome professors. We performed breast reductions under general endotracheal  anesthesia (GEA) in the hospital. While in New York I invented the HALPERN breast marker which is used for breast reductions. Now I do the surgery very differently. I use an  anesthesiologist who utilizes laryngeal mask Anesthesia (LMA) . He first utilizes what I nickname a piña colada (because it looks like one). It is called diprivan. It makes you feel very happy and fall asleep. This is one of the common drugs used when performing IV sedation. Unlike GEA (where you are paralyzed and a machine breaths for you) you are breathing Anesthetic gases through a mask. Unlike GEA, you are doing the breathing. I incorporate the FINNESSE technique which I invented. Advantages include less anesthesia during surgery. Patients typically wake up in either no or little pain. They typically walk to the recovery room (including 77 year old woman) they do not require supplemental oxygen, IV pain medication in recovery and it is not uncommon for patients to only require Tylenol after surgery (including 77 year old patients). Blood loss is typically a few teaspoons. It is not uncommon for patients to to be driving within a week. I hope you find this information useful. For more information please watch the enclosed video.

I have done several thousand breast reductions and would never consider sedation. Reduction is not a skin operation. It involves dissection of the breast tissue and takes over three hours. I would be more afraid of the effects of hours of deep sedation (it would have to be much deeper than for a facelift). You also have to take into account lidocaine morbidity given the amount that would have to be used.  I hear you with respect to fear of intubation. I would suggest that you meet with an anesthesiologist to have an in depth discussion of the anesthesia end of the procedure.

Levels of anesthesia is all related to how deeply your are kept.  Twilight may leave you "aware". If you mean not intubated, that can be done sometimes.  This is a discussion with your anesthesiologist before surgery. Good luck.