Q: Dr. Eppley, Is it possible to have MAC anesthesia instead of a general anesthetic while performing breast augmentation surgery as I have a fear of being fully asleep?
A: The answer of whether breast augmentation could be performed under anything less than a general anesthetic depends on three factors. The first and most important consideration is whether the implants are to be placed above (subglandular) or below the pectoralis muscles. (submuscular) Subglandular breast augmentation can be performed under IV sedation fairly comfortably as there is no muscle dissection. Submuscular breast augmentation is a completely different story, as you might imagine, as lifting the pectoralis major muscle off of the rib cage would not be considered an innocuous procedure. While there may be some plastic surgeons that would do such a procedure under local/Iv sedation, I would not. There is no great comfort level that can be achieved with this muscular maneuver and lack of a supple muscle can limit how well the breast implants can be placed. Secondly there is the unknown variable of patient tolerance. I have see many a patient who says they are ‘tough’ and do not require much anesthesia. In most of these cases this does turn out to be accurate and the execution of the procedure ends up as both challening and very time consuming. Lastly the size of the breast implants play a role. Larger implants can be more uncomfortable to place without a general anesthetic due to the tissue stretch involved.
Dr. Barry Eppley