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Reader Question: Breast Implants Under Local?

Posted Dec 09 2010 10:30am

Reader Question:

A surgeon I’m thinking about seeing said on his site that breast implants were able to be done under local + intravenous anesthetic (like twilight). Can this really be done? I always thought it was too invasive for just twilight, especially if it is under the muscle. Is there an advantage to using twilight? After looking it up there are lots of differing opinions out there but I think that this may just be a way for the surgeon to cut costs. What is the cosmetic surgery truth here, Dr. D?

I am not a fan of local or twilight sleep for breast implant surgery except in rare cases (simple redos and such.) The reasons are patient comfort and practicality. I place most of my breast implants under the pectoral muscles and these muscles need to be relaxed for this to work out. That relaxation is suboptimal under less than a general anesthetic.

An interesting aside to the argument of sedation versus general anesthesia is the fact that under less than a general patients often need more medication to maintain them in a narrow range of alertness. This translates to more drugs for twilight sleep which is contrary to the reason many of these patients wanted less than a general anesthetic in the first place.

Best Regards,

John Di Saia MD

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