Q: Several of my friends have had breast augmentation with you and have loved their results. I am 41 years old and have always wanted larger breasts. My problem is my doctor has informed me that it would not be a good idea go under general anesthesia. The reason being is my mother at age 45, my brother at age 29, and a sister at age 22, all passed away all while under general anesthesia. They never identified a specific cause although my doctor said it is genetic and has told me if I want to do any sort of plastic surgery it would need to be done under a local. Is there any hope for me finding a plastic surgeon who would do my breast augmentation under a local, epidural or something while I am conscious. This is something I have longed for over 15 years. Please respond as soon as possible. I don’t want to go to a cosmetic surgeon and have this done. I want a reputable plastic surgeon such as yourself to perform this. Thank you so much for your time.
A: That family history is the most tragic that I have ever heard in all of my surgical experience. One family member dying under this general anesthesia is rare enough, but three is beyond comprehension. While their diagnoses may not have been known at the time, it is highly likely that your family has the gene for Malignant Hyperthermia. (MH) While not recognized decades ago, it now is and every operating room that does general anesthesia has an emergency kit for its treatment. There is no blood or genetic test for MH. Family history is the only ‘test’ for its presence. Your family history is more than suspicious for this diagnosis.
While you have a likely family history for MH, this does not mean you can not have general anesthesia. The known anesthetic drugs that trigger MH is the muscle paralyzer, succinylcholine, and all of the inhalation agents. General anesthesia without these drugs can be done using narcotics and a propofol infusion, a common combination used in many plastic surgery procedures.
But given your family history, it is also understandable that no matter how a general anesthetic is done you would never feel completely comfortable. Therefore, having a breast augmentation under local anesthesia is possible. (with some oral sedation drugs beforehand) The key to this approach is to place the implant above the muscle (subglandular) and infiltrate the breast first with a tumescent solution for local anesthesia. (much like what is done for liposuction surgery)
Dr. Barry Eppley