Is Awake Breast Augmentation the Best Option?


A commonly asked question is “Can breast augmentation be performed under local anesthesia?”  The answer is yes, but is it the best option for you? If we look back into the history of the operation, as surgical techniques have changed, so have the anesthetic practices.

In the 1960′s and 1970′s, breast augmentation positioned the implant beneath the breast atop the underlying pectoralis major muscle.  This could be done under general or under local anesthesia with IV sedation.

In the 1980′s, surgeons began placing implants beneath the pectoralis major muscle.  The technique was changed for health and cosmetic advantages for the patients. 

Health Advantages

  • Improved view of breast tissue on mammograms-The muscle holds the implant back against the ribcage.  The breast tissue can be “pulled forward” for a clear image to be taken.
  • Lower instance of firmness (capsule)

Cosmetic Advantages

  • Edges of implant not as visible
  • More of a natural “tear drop” shape

The disavantages of placing the implant under the pectoralis major muscle is a greater amount of discomfort both during and immediately after surgery.

In the early 80’s it was common to have an “awake” breast augmentation.  The surgeon would administer IV sedation and injections of local anesthetic.  However, in the late 80’s, a more predictable, safer patient experience was desired and the use of general anesthesia by an anesthesiologist became the standard.  Today, general anesthsia is still the accepted standard with Board Certified Plastic Surgeons.

In the past few years, “awake” procedures have been resurected.  From Facelifts to Liposuction to Breast Augmentation, all of these are being advertised as “awake” and “little or no downtime”.  The question we should all ask ourselves is why? 

With insurance reimbursment declining and business expenses rising, physicians have started looking for other avenues of revenue.  The majority of physicians who are advertising “awake” procedures are not Board Certified Plastic Surgeons.  The physicians advertising “awake” procedures are often specialists in OB/GYN, Emergency Medicine, Family Medicine, Internal Medicine, and other specialties.  Physicians that are not Board Certified in Plastic Surgery cannot perform cosmetic procedures at hospitals or accredidated surgery centers, their only option is to perform the surgery in their office under local anesthesia and oral sedation.

Board Certified Plastic Surgeons maintain the view of general anesthesia being SAFE and providing a SAFER surgery for the patient.

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