Today there are two options for anesthesia in breast-implant surgery: general anesthesia and neuroleptic anesthesia, also known as conscious sedation or twilight anesthesia. Each has advantages and disadvantages, and many surgeons use only one or the other.

Proper Credentials

Make sure any anesthesia is administered by a Board Certified Anesthesiologist (an MD) or a Certified Registered Nurse Anesthetist. Both increase the safety of the procedure by closely monitoring the patient’s oxygen saturation, heart rhythm, heart rate, respiratory rate and blood pressure, as well as comfort and pain control throughout the surgery. Note that the strongest board of certification for plastic surgery offices, the American Association for the Accreditation of Ambulatory Surgery Facilities (AAAASF), requires surgeons to use an anesthesiologist. To verify your doctors’ board certification, visit the American Board of Medical Specialties website.

Before Anesthesia

You will probably be told not to eat anything past a certain time the night before your surgery. If you normally take medication in the morning and wish (or need) to do so the day of your surgery, you must get prior approval from your surgeon. If you get the go-ahead, you should take it with just a few sips of water.

General Anesthesia

Most plastic surgeons insert breast implants under general anesthesia, especially if you opt for “under the muscle” implant placement. During general anesthesia, it’s common to aid ventilation and deliver gases through either an endotracheal tube (ET tube) or laryngeal mask airway (LMA). An ET tube is inserted after you’ve been sedated and removed before you wake up. The LMA is a silicone mask for upper airway management and is less invasive.

Advantages:

  • Maximum protection of your airway
  • Maximum comfort          
  • The surgeon can work more efficiently
  • Amnesia—you will not remember the surgery at all 
  • The muscles are relaxed, allowing the surgeon to adjust the implant position better and shape things perfectly

Disadvantages:

  • Slow awakening
  • Anesthesia “hangover”
  • Discomfort in the throat for 24 to 48 hours post-operatively (if an ET tube is used)
  • Nausea (infrequent; most anesthesiologists use anti-nausea medication)
  • In longer procedures, higher risks of breathing/lung complications and pulmonary embolus

 

Neuroleptic Anesthesia

Conscious sedation is usually given through an intravenous line (IV). After an initial dose of a sedating drug, the breasts are completely numbed with a large volume of diluted local anesthetic.  

There are three levels of conscious sedation:

  • Minimal: You are very relaxed but awake.
  • Moderate: You sleep through most of the surgery but can be awakened easily.
  • Deep: You sleep through the entire procedure. Unlike general anesthesia, you can be roused.

Advantages:

  • No intubation
  • It’s possible to choose your implant size during surgery
  • No pain during surgery
  • Less pain after surgery (usually)
  • Quick recovery—patients generally wake within 15–30 minutes    
  • Amnesia—patients rarely remember the procedure
  • Less “hangover”
  • Significantly less nausea
  • Lower cost

Disadvantages:

  • Additional time and effort at the beginning of the procedure to correctly place local anesthesia
  • Harder to continuously adjust the correct level of sedation
  • Headache
  • Unpleasant memories of the surgery (infrequent)
  • Possible allergic reactions, including: skin irritation, swelling, temporary breathing problems, and very rarely, seizures or irregular heartbeat 
  • Possible emergency intubation

The best way to protect yourself from anesthesia-associated risks is to make sure that your anesthesiologist and surgeon know your medical history, as well as all medications you take. Make sure to include over-the-counter drugs and herbal and dietary supplements since these can also interfere with anesthesia.