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Your Breast Agumentation Anesthesia Choices

The whole idea of anesthesia can be frightening for many people. It is a scary concept to be put to sleep and not be in control of your own body. But being informed about anesthesia can lessen your fears.

Although we are talking about your options in anesthesia for breast augmentation surgery, the decision on what type to use for you may be dictated by factors such as where the cosmetic surgery is taking place, your general health, who is administering the anesthesia, and your surgeon’s preferences. Make sure you discuss anesthesia with your surgeon.

Do We Need Anesthesia For Breast Augmentation?

We need anesthesia during breast augmentation surgery and other medical procedures for several reasons. Anesthesia prevents the patient from feeling pain, immobilizes the patient, and controls many of the body’s defense mechanisms that have to do with pain. You can tell the difference between a surgical incision that is necessary and an accidental cut or other wound, but your body cannot.

As soon as your body is wounded or injured in any way—even surgically—your body goes to work to protect itself and start to heal. Your body goes into what is called a “flight or fight” mode. It readies itself to get away from or fight whatever is causing the injury. To do this, your heart rate quickens, your blood pressure goes up, your breathing rate may increase, and your body starts to try to repair the injury with a vengeance. These are autonomic responses on the part of your body, which means that you do not have conscious control over them. Anesthesia blocks these reactions until after the surgery is over and keeps your body from trying to overwork itself during surgery.

Anesthesia also helps prevent you from remembering your surgery. Cosmetic surgery can be traumatic to the body and remembering this trauma can interfere with healing. Healing is actually better and faster when you do not remember the pain of surgery.

Anesthesia works in five ways:

1. It is an analgesic (a pain reliever)

2. If prevent you from remembering the experience

3. It promotes unconsciousness

4. It immobilizes you

5. It reduces or eliminates your body’s autonomic responses to trauma, such as tachycardia (increased heartbeat), increased breathing, and elevated blood pressure (hypertension).

Types of Anesthesia and your Options

There are several types of anesthesia, some of which are used in breast augmentation surgery. Not all surgeons offer the choice of all types of anesthesia.

The four main types of anesthesia are:

Local anesthesia
Regional anesthesia (nerve blocks)
Conscious sedation
General anesthesia

Local Anesthesia

Local anesthetics numb a small area and are used to stop pain in the immediate area of the surgery. You may have had local anesthesia if you needed stitches or when you were having dental work. It usually consists of an injection of a local anesthetic. Local anesthetics can be used in cosmetic surgeries such as rhinoplasty (nose job) in addition to sedation. Usually, a local anesthetic numbs only the skin or tissues just below the skin.

The drugs used in local anesthetic shots most commonly are lidocaine (one brand name for lidocaine is Xylocaine) or bupivacaine (brand name Marcaine). There are many different local anesthetics each of which have different rates of absorption, toxicity, and duration of action.

I have had local anesthesia many times, mostly for lip augmentation procedures or in the dentist's chair. It feels like a typical shot, like a pinprick. It tingles or stings just a little as it is going in and then it starts to take effect. Just like with a shot in the dentist’s chair, the area that got the shot becomes numb. It may feel like it is twice the size as normal. The numbness begins to wear off after a few hours or so, depending upon the dose. When feeling returns to the area, it may feel tingly, almost like when your arm or foot "falls asleep." For some procedures, you may get several injections of local anesthetic to cover the area to be treated.

Regional Anesthesia

With regional anesthesia, a region of the body is anesthetized without rendering the patient unconscious. The anesthetic is injected around a major nerve or the spinal cord to block sensation in a larger area than with local anesthetic injections. You might hear regional anesthesia called a peripheral nerve block. Epidural and spinal anesthesia, which are often used in childbirth, are types of regional anesthesia. Usually, you will receive a mild sedative to relax you along with regional anesthesia.

In cosmetic surgery, regional anesthesia is often used in facial procedures, such as brow lift touch ups, lip reduction and augmentation surgeries, chemical peels, and liposuction under the chin. It is usually not used in breast augmentation surgery.

Conscious Sedation

Conscious sedation is usually administered by intravenous (IV) line and makes you relaxed and drowsy. The medications for conscious sedation may also include muscle relaxants, pain medications, and drugs that can cause temporary amnesia. They can customize the mix of drugs specifically to suit you and what procedure you are having.

Usually, an IV line is placed into a vein on the inside of your elbow. Occasionally, they may use a vein in the back of your hand. Having an IV inserted is similar to having blood drawn. It may sting a bit at first. After the needle is placed into the vein, the needle is pulled out and a little plastic tube is left in your vein. This tube is called a catheter, and it is taped to your skin to hold it in place. In most cases, a nurse or a staff member will attach a bag of fluid to the IV line, but the line is shut with a little roller device until the IV line is needed. The bag is usually filled with saline (sterile saltwater) and medications can be added to the bag and dripped into you along with the saline. The saline will keep you hydrated both during and post-operatively.

The effects of IV anesthesia are felt very soon after the medications start to flow into you. It may feel like heat going into your veins then creeping up your arm.

You may also receive oral sedatives, such as Valium (diazepam) or Xanax (alprazolam) by mouth an hour to an hour and a half before a surgical procedure. These drugs can help you relax and help alleviate anxiety. Oral sedatives make you calm and drowsy. You may even fall asleep depending on the dosage.

General Anesthesia

General anesthesia is used for more extensive surgical procedures or for any procedures where other forms of anesthesia should not be used for some reason. For example, small children will often receive general anesthesia even for relatively minor procedures because it will keep them from moving during surgery. General anesthetics are usually given in the form of liquids via IV or inhaled gases or both.

General anesthesia affects your entire body, which means there is a greater chance of a side effect than with other forms of anesthesia. However, only a very small percentage of people have any problem with general anesthesia and most side effects are temporary. Because you are unconscious, your vital signs, such as your breathing and heartbeat will be monitored.

Often with general anesthesia, you are given a sedative and medications that may interfere with your memory before general anesthetics are administered. These may be given orally or by IV. You may be sleepy before you get to the operating room and, after the surgery, you may not remember being brought into the operating room even if you were still awake at the time.

Whether you remember it or not, in the operating room, a breathing mask will be placed over your face and nose and you start to breath in the gas. After the gas is started and you are unconscious, the anesthesiologist or the anesthetist will take away the mask and put a tube down your airway to continue administering the gas. This tube will also help ensure that your airway (your lungs and throat) stay open. After the surgery, your throat may be a bit irritated or sore. Your throat and mouth may also feel very dry.

Being nervous about undergoing anesthesia is very normal. If you are very anxious, you can ask your cosmetic plastic surgeon or the anesthesiologist for an antianxiety drug such as Valium or Xanax that you can take the night before or the morning of surgery. Never take any medication before surgery without your anesthesiologist and surgeon knowing about it.

Why Shouldn't I Eat Before Surgery?

You must fast before anesthesia so that you don’t have any undigested food in your stomach that you might throw up. Vomiting while you are lying on your back is unpleasant enough, but you might inhale some of the material into your lungs, which is dangerous. Anesthesia can interfere with your normal reflexes, such as the reflex in your throat and airway that keeps you from choking.

Take your surgeon’s instructions about when to stop eating very seriously. You will be told not to eat anything past a certain time the night before your surgery. Usually, you will be told to start fasting at midnight the night before, but you might be told to eat nothing after 10 p.m.

If you must take a medication in the morning before your surgery (with your surgeon’s approval) take it with only a few sips of water.

Who Will Administer the Anesthesia?

Anesthesia can be administered by an anesthesiologist, who is a medical doctor trained in anesthesia and pain management, or by a nurse-anesthetist, who is a nurse specially trained in administering anesthesia. Many hospitals and freestanding surgical units use nurse-anesthetists, who are registered nurses who are certified in administering anesthetics. You may see the letters CRNA after the person’s name, which stands for certified registered nurse anesthetist. In some instances, the surgeon performing the procedure may administer some forms of anesthesia.

Recovering from Anesthesia

Coming out of anesthesia varies from person to person and from experience to experience. Even if you had anesthesia in the past and woke up well, you might be uncomfortable the next time, and vice versa. You may wake up gradually or abruptly; you may feel hot or cold or a bit numb. You may feel nauseous or have a fit of crying or giggling. All of these reactions are normal. Often, you may feel a bit confused and think you haven’t even gone into surgery yet, since it won’t seem like any time has passed.

As you come out of anesthesia, the staff will monitor you. You may still be hooked up to monitors that will keep track of your breathing and heart rate. You may be wearing a small device clipped to a fingertip or earlobe that tells how much oxygen you have in your blood.

When I begin to regain consciousness I feel very cloudy, like my peripheral vision is gone temporarily and everything is of a white, blanched hue. I get emotional sometimes and this is very normal.

Some patients become nauseated. If you feel you are about to throw up, alert one of the nurses. He or she can give you a few sips of cool water or ice chips, which can help settle your stomach, and provide you with container in which to vomit. You probably won't be given anything to eat or drink yet. Some cosmetic plastic surgeons may give you an antinausea medication to decrease your risks of vomiting after your surgery.

Some patients fell cold and begin shivering as they come out of anesthesia. If you feel cold, let the staff know so he or she can give you a warm blanket.

If you are going home that day, you will be kept in a recovery area until you are out of anesthesia. You may still feel somewhat groggy. The staff will go over all your instructions to make sure you understand what you need to do when you get home and in the days that follow.

You will not be allowed to go home unaccompanied by an adult and you will not be allowed to drive yourself home. Make sure that you have arranged for a responsible adult to take you home after your surgery. Some surgeons insist that a responsible adult must stay with you overnight as well. If you do not have such an arrangement in place, your surgery may be canceled before it begins or you will be kept in the hospital overnight.

Understand also, that you might be kept in the hospital or surgical center overnight if there were any problems with your cosmetic surgery. Even though you planned to go home, a complication like elevated blood pressure, severe nausea, or bleeding that was out of the ordinary may make your surgeon decide you need to be observed overnight. It is better to be safe than sorry in this type of situation.

Risks, Contraindications, and Complications of Anesthesia

The vast majority of patients have no problems with anesthesia. That does not mean that anesthesia is risk free. The information here is not intended to scare you off from having surgery. It is here to make sure you are making an informed decision.

The best precaution you can take before having anesthesia is to talk to your surgeon and to the person administering anesthesia. Make sure that they both know all about your health and any allergies you have, as well as any problems you have ever had with anesthesia. If other people in your family have had problems with anesthesia, mention that, too. Several health conditions—or the medications you take for them—can change the way your body reacts to anesthesia.

Serious problems with anesthesia are usually linked to the circulatory and respiratory system. Make sure that your surgeon and the anesthetist or anesthesiologist know if you have ever had any serious breathing problems, such as asthma, chronic bronchitis, or allergies that cause you breathing difficulties. You may still be able to have surgery safely if you have had breathing and lung problems such as these, but both your surgeon and whoever administers anesthesia should know in advance so that they can take precautions.

Smoking increases the chances that you may have breathing difficulties during surgery. It also impairs your ability to heal later. If you smoke, you will be told that you should avoid smoking and tobacco products for a time before and after your surgery. This goes for smoking marijuana, too.

Make sure your cosmetic plastic surgeon and the anesthetist/anesthesiologist know if you have ever had any heart-related problems, such as a heart attack, heart failure, high or low blood pressure, a history of clotting problems or embolisms, or irregular heartbeat. Here again, you may have no problems with surgery or anesthesia, but precautions may be necessary.

Medication and Supplement Contraindications for Anesthesia

There are many medications and dietary or herbal supplements that you should not take before or after going under anesthesia. Make sure that your surgeon and the person administering anesthesia has a complete list of all the medications you take. This list should include everything, including vitamin and nutritional supplements and any herbal products that you take regularly. If you smoke marijuana or take any recreational drugs, say so.

If you take antidepressant medications, please advise your surgeon. Some antidepressants are monoamine oxidase (MAO) inhibitors (also known as MAOI) and they can intensify the effects of the anesthesia. This interaction can occur even weeks after you have stopped using an MAO inhibitor. This could be a problem if your doctor is unaware of your medication usage. If you advise your doctor, he or she can make adjustments for your anesthesia.