Awake During Breast Augmentation Surgery. Possible? by Dr. Sando
A commonly asked question is “Can breast augmentation be performed under local anesthesia?” To answer that, I would like to take you back into the history of the operation because as surgical techniques have changed, so have the anesthetic practices.
Early on, in the 1960’s and 1970’s, breast augmentation positioned the implant beneath the breast atop the underlying pectoralis major muscle. This could be done under general or under local anesthesia with IV sedation.
In the 1980’s, we began placing implants beneath the pectoralis major muscle. The health advantage was an improved view of breast tissue on mammograms because the muscle held the implant back against the ribcage so that the technician could pull the breast forward (the “pull away” or Eklund maneuver) and a clear image taken. The cosmetic advantages included camouflage of the implant edges beneath the muscle, creation of the teardrop shape by the muscle’s compressing and flattening the uppermost part of the implant, and the lowered occurrence of firmness (capsule) problems when this position was used with gel implants. A drawback, however, was greater pain symptoms during and immediately after this operation compared to the former on-top-of-the-muscle implant placement. Initially, simple local anesthesia and IV sedation with patient awake, (using drugs like Valium, Demerol, and Ketamine) was popular. Gradually, however, toward the latter 1980’s, the decision was made across the country that a more predictable, safer patient experience was delivery of a general anesthetic by an anesthesiologist. This remains the accepted standard. Occasionally, a patient will opt for a monitored anesthetic in which the surgeon delivers numbing shots and the anesthesiologist administers deeply sedating medicine like IV Propofol, but most regard general anesthesia as the preferred, very safe approach.