The anesthesia used for breast augmentation can vary depending upon the preference of the breast surgeon and the specific situation and preferences of the patient. A good general rule for anesthesia is to use only the level of anesthesia required for the procedure and no more. For example, a dentist typically uses only local anesthesia to repair a tooth. Local anesthesia is all that is required for this procedure and so any additional anesthesia is unnecessary and could add to patient risk. When a cardiac surgeon performs coronary bypass surgery, the patient is fully asleep and paralyzed because this level of anesthesia is required for this type procedure. This type of anesthesia is referred to as “general anesthesia”. These are the extremes of anesthesia levels (“planes”) and there are many anesthesia techniques that are “in between” these two (more than local anesthesia and less than general anesthesia). Many different anesthesia techniques have been used to perform breast augmentation from local anesthesia alone to general anesthesia. Plastic surgeons preferences will vary as to which anesthesia technique is chosen depending on many factors (the depth of anesthesia needed). There are three general requirements to consider when determining which anesthesia technique to choose. The first, most important, and most obvious consideration is patient safety. In choosing an anesthesia technique the type of procedure and specific individual patient factors are considered. Following the previously noted general guideline, the safety factor would likely be highest when using only as much anesthesia that is required. A dentist does not need general anesthesia (with some exceptions) to repair a tooth. The dentist needs and only uses local anesthesia in most patients. The second requirement for choosing an anesthesia technique is patient comfort. With modern anesthesia techniques and medicine, the highly trained anesthesia professional will typically use as much anesthesia as needed to provide patient comfort and no more. The third requirement for a choice of anesthesia is related to the technical ease of the procedure.
Modern anesthesia drugs for Plastic surgery have a very short half life and redistribute (go into the body tissues) quickly. This means the drugs are metabolized (used up by the body) or are inactive very quickly after they are administered. There are many advantages to anesthesia drugs with a short half life. After the surgery, these modern drugs do not cause a multiple day hangover as the anesthesia drugs did thirty years ago. Patients require different amounts of drugs for sedation, and a short half life also allows very accurate titration, which means the exact amount of drugs can be administered. As a result, the patient will get the necessary amount of drugs, and not too much. Use of these modern drugs also precludes some of the problems that were seen in patients previously, including malignant hyperthermia. Malignant hyperthermia is a reaction some patients have to certain “triggering” agents (drugs) resulting in a a hypermetabolic state, and requires immediate treatment. Malignant hyperthermia is not “triggered” by sedation drugs commonly used for Plastic surgery, including breast augmentation, which is another advantage of this protocol. Anesthesia professionals are well trained in the use of these modern drugs.
The level and type of anesthesia should facilitate the technical maneuvers required for each operation. For example, some operations require the paralysis of muscles in order to perform the operation, and in this case general anesthesia is required. Many different anesthesia techniques have been used to perform the breast augmentation procedure including local anesthesia alone, local anesthesia plus oral sedation, local anesthesia plus regional block, local anesthesia plus intra-venous sedation, and general anesthesia. Local anesthesia alone would meet the safety requirements, but may not meet the comfort and technical requirements. As a result, local anesthesia alone may not be the best choice. General anesthesia (with the patient paralyzed) would meet all three requirements, but does have other potential disadvantages including adverse reactions to medicine, airway problems, pulmonary (lung) problems, and circulation (deep vein thrombosis) problems. While general anesthesia is considered very safe, paralysis of a patient is not usually necessary to perform a breast augmentation. Studies have shown that some muscle tone (patient is not paralyzed) does decrease the chances of the patient getting lower extremity deep vein thrombosis (blood clot in the leg) during or after surgery. Deep vein thrombosis can lead to pulmonary embolus (blood clot in the lung) which can be a fatal event. All those things considered, many surgeons choose local anesthesia plus intra-venous sedation to perform the breast augmentation procedure, and this anesthesia technique has been proven to meet the three aforementioned requirements for breast augmentation surgery. While there are no hard and fast rules for choosing an anesthesia technique for the breast augmentation procedure, the use of local anesthesia plus intra-venous sedation is a widely used and excellent option. Patients seeking breast augmentation frequently ask about and report previous episodes of nausea after receiving anesthesia. Some patients are more susceptible to post operative nausea than others. There are many factors that are thought to contribute to post-operative nausea including medicine, dehydration, certain types of surgery, and a general predisposition. One risk factor for post-operative nausea is a history of motion sickness. In this group of patients, extra precautions are taken to prevent post-operative nausea. All patients (in my office) are pretreated for possible nausea when getting a breast augmentation. Using a long tested protocol, nausea after breast augmentation is rare.