Breast augmentation with IV anesthesia – a safer and better choice

Modified on | by Dr. Ricardo L. Rodriguez

I often hear from patients who want to have a Breast augmentation, but are afraid of anesthesia, or “going under.” They are concerned about the postoperative nausea,  and feeling rotten for a couple of days after anesthesia. It doesn’t have to be so.

The choice of anesthesia for Breast Augmentation are either General Anesthesia or IV anesthesia. With IV anesthesia the recovery is very quick, less nausea, and no lousy feeling the days after surgery. In addition, the risk of getting a blood clot or pulmonary embolism is almost eliminated.

IV anesthesia as an alternative to General Anesthesia

There are two keys to successful breast augmentation with IV anesthesia. The first is using the newer combinations of intravenous anesthetics. A short acting barbiturate, such as propofol, is used with a dissociative anesthetic. 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.

The recovery room experience is much improved with IV anesthesia. First of all, the patient wakes up much quicker. Secondly, there is hardly any nauses. When I used General Anesthesia in the past, I used to prescribe Zofran (anti-nausea drug).

Since I have been using monitored IV anesthesia  I rarely need to prescribe nausea medications. The recovery room stays are now so short, that the patient is fully awake, walking and ready to go home within an hours time.

IV anesthesia eliminates DVT and pulmonary risks

With IV anesthesia there is no risk of malignant hyperthermia or blot clot to the legs or lungs, as those risks are only associated with general anesthesia. Thus, properly monitored IV anesthesia is a safer choice than general anesthesia for Breast augmentation.

Post op recovery with IV anesthesia is quicker

Two days after Breast augmentation surgery, I usually see patients to remove the drains. At this appointment, I see a remarkable improvement in their recovery compared to patients that I formally used General Anesthesia with.

When I previously usee General Anesthesia for Breast Augmentation, the patients used to show up in pajamas, hair undone,  and a bit wobbly. The most often asked questions are how long the pain is going to last, and can I refill the pain medication prescription.

Undoubtedly, Breast augmentation with  IV anesthesia has been a great advance in patient care for my patients and I highly recommend it to anyone contemplating Breast augmentation.

(originally posed on March 14, 2009)

By Dr. Ricardo L. Rodriguez MD Board Certified Plastic Surgeon Cosmeticsurg Baltimore, Maryland Ricardo L. Rodriguez on American Society of Plastic Surgeons.

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6 thoughts on “Breast augmentation with IV anesthesia – a safer and better choice”

    • Dr. Ricardo L Rodriguez says:

      We are well aware of this. Our site is staffed only by MD anesthesiologists. Our technique for induction is not a loading dose, which can in rare instances lead to events you describe, or lead to situations like Michael Jackson's. ANY medication used for anesthesia can cause problems when not properly administered. Our technique is a slow drip regulated by automated pump so there is no chance of overdosing. After the patient is sedated we add a small dose of Ketamine and Versed, enough to tolerate the injection of the tumescent anesthetic. We do not depend on propofol levels for anesthesia, only for light sedation.

  • Dr York Yates says:

    Nice post Dr. Rodriguez. That is actually very similar to my technique. I use propofol without general anesthesia and a lot of local anesthetic. I find in my hands that infiltrating the local directly under the pectoral muscle helps with pain control and particularly hemostasis. I rarely have to use any cautery. Pain pumps are a good idea. I use Marcaine in the implant pocket after closure for long lasting pain control without the expense or hassle of the pain pumps but have certainly considered the pain pumps. I had done general anesthesia for the first half of my career and now wouldn't consider going back. Much easier on the patient and in my practice means it becomes an office procedure at significant cost savings to the patient. We do full abdominoplasty, breast reduction, and breast lift with similar anesthetic techniques.

    • Dr. Ricardo L Rodriguez says:

      Thanks for the backup. For me the most difficult part was finding anesthesiologists who would go along with it. The best part is the postoperative recovery for patients. Many many less headaches for them and me! Will look you up in Seattle.

    • admin says:

      Yes, we do all surgery under twilight. Patients recover much better. Less nausea, less tiredness after, etc. Highly recommend it!