Anesthesia for Breast Augmentation:

There are many different types of anesthesia that can be used for breast augmentation surgery. Which one you receive depends on the type of surgery, the facility where it is being performed, your general health and the preferences of your breast surgeon.

Anesthesia does have risks attached to it, but fortunately, major side effects and complications are rare. Your personal risk profile depends on the type of anesthesia used, your overall health and how you respond to the chosen anesthetics. Anesthesia should be administered by an anesthesiologist or by a nurse-anesthetist. These professionals are specifically trained to administer anesthesia. (You may see the letters CRNA after the nurse's name, which stands for certified registered nurse anesthetist.)

There are four main categories of anesthesia:

• General anesthesia. You are asleep.
• Local anesthesia. The specific location that needs surgery is numb.
• Sedation anesthesia ("conscious sedation"). Your level of consciousness is altered.
• Regional anesthesia. The area of your body that requires surgery is numb. Regional anesthesia is not used with breast augmentation.

General Anesthesia

General anesthesia is used for invasive surgical procedures. It affects your entire body. General anesthetics are usually given as liquids via IV, inhaled gases or both. It is often the type of anesthesia used for breast augmentation.

Risks of general anesthesia include:

• Aspiration (when an object or liquid is inhaled into the respiratory tract)
• Breathing problems
• Allergic reaction
• Increased blood pressure
• Elevated heart rate
• Damage to teeth and lips
• Swelling in the larynx
• Sore throat, hoarseness
• Heart attack or stroke (rare)
• Nausea and vomiting
• Delirium
• Swelling
• Infection
• Malignant hyperthermia (see sidebar)
• Systemic toxicity (rare)
• Death (About one in 250,000 people die from complications of general anesthesia. The risks are greater for those people with serious medical conditions).

Local Anesthesia

Local anesthetics numb a small area and stop pain only in that immediate area (think dental work or stitches). They are usually given via injection directly into the site. Risks associated with local anesthesia are slim. There is, however, a chance that the medications will be absorbed by your body, causing a serious systemic reaction.

Local anesthesia may be used with conscious sedation during breast augmentation. In this scenario, the breast area is infused with a local anesthetic agent such as lidocaine or marcaine to provide numbness in the operative area.

Sedation Anesthesia (Conscious Sedation)

Conscious sedation is usually administered via intravenous (IV) line. There are three levels of conscious sedation:

• Minimal sedation: You are very relaxed, but awake.
• Moderate Sedation: You sleep through most of the surgery but can be awakened easily.
• Deep Sedation: You will sleep through the entire procedure. Unlike with general anesthesia, you can be aroused with stimulation during deep sedation.

Patients receiving conscious sedation rarely remember the procedure, though it has been known to occur.

Risks of conscious sedation include:

• Headache
• Hangover
• Nausea and vomiting
• Unpleasant memories of your surgery

Conscious sedation is often used with a local anesthetic agent during breast augmentation.

Regional Anesthesia

With regional anesthesia, an area of your body is anesthetized. Think epidural during childbirth; other examples include spinals and peripheral nerve blocks. Regional anesthesia is not used during breast augmentation surgery.

The risks of regional anesthesia include:

• Nerve damage (resulting in persistent numbness, weakness, or pain)
• Systemic toxicity
• Heart or lung problems
• Infection
• Swelling
• Bruising at the injection site.

A spinal, or spinal anesthesia, is a form of regional anesthesia. During spinal anesthesia, medication is injected into your spinal canal to numb the nerves in the lower half of your body. If spinal fluid leaks, you may experience a severe, debilitating spinal headache, These headaches are treated with a blood patch, a procedure in which your surgeon injects a small amount of youth blood into the area where the leak is most likely occurring to seal the hole.

Before Anesthesia

You will be given a list of instructions before your surgery that you must follow to a T. This will help minimize the risk of complications. If other people in your family have had problems with anesthesia, mention this.

You will likely 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 to do so the morning of your surgery, you must get prior approval from your surgeon; if you get the go-ahead, you will likely be instructed to take it with just a few sips of water.

If you are very anxious, you can ask your cosmetic plastic surgeon or the anesthesiologist for an anti-anxiety drug. Some cosmetic plastic surgeons may give you an anti-nausea medication to decrease the risk of vomiting after your surgery. Make sure you are clear about what you can and can't do before your surgery.

Anesthesia Recovery

Your recovery from anesthesia will depend on the type of anesthesia used for the procedure and how you respond to it. With general anesthesia, for example, you may wake up gradually or abruptly. You may feel hot, cold or numb; if you feel cold, ask for a blanket. You also may feel nauseous, sad or have a laughing fit. In addition, your throat may be sore and your mouth may be extremely dry.

You may think you haven't even gone into surgery yet, since it won't seem like any time has passed.

You will be carefully monitored in a recovery area or room as you wake up from your surgery. You may be wearing a small device clipped to a fingertip that tells how much oxygen you have in your blood. If you experience complications, you may need to stay overnight. If all goes well and you do not have any complications, you will still need someone to drive you home after your breast augmentation surgery — in part due to the lingering effects of the anesthesia.

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 what medications you currently take. Make sure to include herbal and dietary supplements as these, too, can interfere with anesthesia.

More Info:

Questions to ask your anesthesiologist.

• What type of anesthesia do you recommend for my breast augmentation procedure? Why?
• What are the risks attached to the recommended anesthetic?
• Will I receive written preoperative instructions?
• Who will be administering the anesthesia?
• Will I meet with an anesthesiologist before surgery?
• Will I be monitored during the surgery?
• Where will I recover?
• Who staffs the recovery room? Are they qualified to handle an emergency?

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