Awake Breast Augmentation – A Safer Choice
We often hear from patients who want to have breast augmentation surgery that they are afraid of anesthesia, of being “put to sleep” or “going under.” Awake Breast Augmentation could be the answer. They are concerned about the post-operative nausea, and the general “lousy” feeling that can linger for a couple of days after general anesthesia. Well, it doesn’t have to be that way. There are well-studied techniques for doing breast augmentation with another type of anesthesia – awake or twilight anesthesia. My patients are ‘awake’ in the sense that they are not put to sleep or placed in an unconscious state of complete paralysis using general anesthesia. We have been performing breast augmentation surgery using this technique for almost five years with great success in our accredited surgical center. Patients experience a quicker recovery, experience less nausea and vomiting, and avoid that ‘lousy’ feeling that can last for a few days after general anesthesia.
IV Sedation for Awake Breast Augmentation
There are two keys to successful breast augmentation with ‘awake’ or twilight anesthesia. The first is using the newer combinations of intravenous (IV) anesthetics. A short acting barbiturate, such as propofol, is used with a dissociative anesthetic, which as the name implies, dissociates painful stimuli from higher levels of brain activity. The patient is then not as heavily sedated and can breathe on her own. Another drug used is an amnesic, which prevents formation of memory of the event. More importantly, using this combination, there is very little need, if any, for narcotics. Narcotics are a major source of post-operative nausea and vomiting.
IV anesthesia allows a patient to have a surgery where she is awake enough to be breathing on her own, will not experience pain, and will not remember the event. With IV anesthesia there is no risk of malignant hyperthermia or blood clots to the legs or lungs, as those risks are primarily associated with general anesthesia. Thus, properly monitored IV anesthesia is a safer choice than general anesthesia for breast augmentation when administered by an anesthesiologist or certified registered nurse anesthetist.
Local Anesthesia –Nerve Block
The second key is blocking the nerves before starting the breast augmentation surgery. In the chest cage the nerves emerge from the intercostal (between the ribs) spaces along the mid-axillary line, and intercostal spaces along the sternal borders. They provide sensation to the tissues of the breast along parallel tracks that are called dermatomes. If you can block the nerves close to those spaces, you can numb the entire breast without having to inject the entire breast tissue with local anesthetics. Once the nerves are blocked, there are very few pain signals reaching the brain.
The image below depicts the placement of the local anesthesia as described. The pink areas indicate the areas where the local anesthetic is injected. I administer the local anesthesia after the IV sedation has you relaxed and before any incisions are made. The local anesthetic that I use is long lasting and numbs the nerves for 12 to 18 hours. The patient will wake from anesthesia with little, if any pain.
Faster Recovery for Awake Breast Augmentation
The recovery room experience is much improved with ‘awake’ twilight anesthesia. First of all, the patient wakes up much quicker. Secondly, there is hardly any nausea. Occasionally, I may prescribe Zofran, which will give the patient relief from nausea if they experience any. The recovery room stays are shorter, the patient is fully awake, walking and ready to go home within an hours time.
I see all of my breast augmentation patients within 24 hours and they are doing remarkably well. They have no complaints of the surgery and were comfortable throughout the entire procedure. Of course, most are experiencing some pain after breast augmentation surgery, but are getting relief from the prescribed pain management medications.
Undoubtedly, breast augmentation with ‘Awake’ IV sedation has been a great advance in patient care for my surgical patients and I highly recommend it to any one considering breast augmentation.
To learn more about AWAKE Breast Augmentation schedule your complimentary consultation. Call 407-258-3182 today!
Dr. John Serrão
Serrão Rejuvenation Center
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