Need advice ASAP--anybody had gynecomastia surgery with local anesthesia ONLY?

[CAMack2010]

Hey folks,

I am scheduled for gynecomastia surgery on Thursday.  In these final days before the procedure, I'm still deciding whether I want to have the procedure done under general anesthesia (i.e., putting me to sleep), or just local to numb the chest.   I have very minor gyno (puffy nipples only).  My doctor does not do heavy sedation along with local anesthesia, so this si not an option.  I may be able to get a light sedative, but essentially my two choices are: 1) local anesthesia only (possible light sedative), or 2) general anesthesia.

Has anybody here had the procedure performed under local only?  I will likely be having both liposuction and direct excision for gland removal.  I am very hesitant to let them put me under for an elective procedure like this, especially when my gynecomastia is so minor.  But if the procedure is very uncomfortable under local, I may consider letting them use general.

Any thoughts would be much appreciated.

[Dr. Elliot Jacobs]

I can only talk in general because obviously I haven't examined you.

In my experience, the only time I would use local anesthestic is if you are very slender (or have very low body fat %) and have just a small amount of breast tissue directly under the areola (this frequently happens with body builders).

If you have tissue which extends beyond the edge of the areola, a good part of that is fat, which can be removed with liposuction.  Problem is local anesthesia for that really doesn't work too well -- and the pain can be quite tough.  Then you would need either general anesthesia or, as I very often do, intravenous sedation provided by a separate anesthesiologist.

If you are conflicted, then I would recommend general anesthesia.  This is a once in your lifetime (hopefully) operation -- why endure pain when it can be made totally pain free?

Dr Jacobs

[CAMack2010]

Thanks for the input Dr. Jacobs.  My gynecomastia is mostly concentrated under my areola, with a little bit to the outside (i.e., towards the side of my body).  Again, it is quite minor.  My surgeon will be starting with lipo and, depending on how it looks, may or may not proceed to do a direct excision.

Would you describe the sensations of having lipo under local anesthesic as actually "painful," or just uncomfortable?  From my understanding, the anesthetic eliminates just about all of the pain, but what the patient will still feel is various pulling, tugging, and pressure-type sensations.

[CAMack2010]

Oh, and would anybody who has had this procedure as a patient with local only care to weigh in as well?

[Dr. Elliot Jacobs]

Local anesthesia is interesting -- it can make a scalpel incision through the skin totally pain free.  But there are other types of nerve fibers which respond to "pulling" sensations.  Those are not numbed with local anesthesia.  As a result, the pushing and pulling through the tissues of liposuction are not well controlled with local anesthesia alone.  There is pain involved, to be truthful -- not just discomfort.  When I first began doing gyne surgery many years ago, I felt I could do much of it under local anesthesia.  I was wrong.  When I started to do the lipo part, my patients just couldn't take it.  The many nail scratches on the ceiling of my OR are testimony to that.

Dr Jacobs

[DrBermant]

Hey folks,

I am scheduled for gynecomastia surgery on Thursday.  In these final days before the procedure, I'm still deciding whether I want to have the procedure done under general anesthesia (i.e., putting me to sleep), or just local to numb the chest.   I have very minor gyno (puffy nipples only).  My doctor does not do heavy sedation along with local anesthesia, so this si not an option.  I may be able to get a light sedative, but essentially my two choices are: 1) local anesthesia only (possible light sedative), or 2) general anesthesia.

Has anybody here had the procedure performed under local only?  I will likely be having both liposuction and direct excision for gland removal.  I am very hesitant to let them put me under for an elective procedure like this, especially when my gynecomastia is so minor.  But if the procedure is very uncomfortable under local, I may consider letting them use general.

Any thoughts would be much appreciated.

Local anesthesia alone is not enough to maximize comfort for good chest contouring. Plastic Surgery Anesthesia is an art form.  Sedation manages the patients conscious level.  Local and Tumescent Anesthesia manage the numbness and comfort.  For almost all of my gynecomastia surgery, local anesthesia with sedation provides a safer much more comfortable method.  The patient starts with medication from an IV given by my Anesthetist.  He is an artist who blends various medications that gently drift each patients off to sleep.  We have been working as a team for many years.  By the end of the operation the patient awakes, comfortable, with no nausea, and unaware of the time that has transpired.  My local anesthesia and tumescence is given after the patient is asleep. 

I prefer local anesthesia alone for long nipple reduction gynecomastia. For almost all other gynecomastia surgery, local anesthesia with sedation provides a safer much more comfortable method.  When 2 stages are needed, as with this problem of enlarged nipples of gland and nipple tissue, I perform the first stage with local sedation, and the second with local alone.  For my upper body lift surgery, when I have to operate all around the chest - front / back, I need Light General Anesthesia.  This is still my Tumescent Technique, but adds the safety of airway protection while the patient is in the prone position.

I perform many revision gynecomastia surgery on patients first done elsewhere.  Many have told me how unpleasant their first doctor's experiences were under local anesthesia alone or General Anesthesia for liposuction and gynecomastia surgery.

You can find an extensive individual patients' experience with comfort and my Tumescent Technique Anesthesia for gynecomastia here.

If you prefer direct links to each of those discussions:

• anesthesia and comfort in gynecomastia patient from California
• anesthesia and comfort after revision gynecomastia surgery in patient from Hong Kong China
• comfort and anesthesia in physician's son with gynecomastia
• comfort and anesthesia in gynecomastia patient from Florida
• comfort and anesthesia in gynecomastia patient from Illinois
• comfort and anesthesia with gynecomastia patient from Texas
• comfort after gynecomastia surgery with patient from Colorado
• comparing comfort and anesthesia of my revision surgery with prior gynecomastia surgery in Florida
• comfort and anesthesia in patient 4 hours from Richmond with gynecomastia
• parent of teenage gynecomastia patient commenting about comfort after surgery
• comfort after gynecomastia revision surgery on patient from the United Kingdom
• comparing comfort of my revision surgery to prior gynecomastia surgery done in New York

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia Male Breast Reduction Surgery

[CAMack2010]

Anybody else with any thoughts on this?

[headheldhigh01]

i can't speak from experience, but i had general once and it was fine, that's what i would do.  even if all the tugging etc was painless, it's memories i personally just wouldn't want to have.  

...As a result, the pushing and pulling through the tissues of liposuction are not well controlled with local anesthesia alone.  ...  When I first began doing gyne surgery many years ago, I felt I could do much of it under local anesthesia.  I was wrong.  When I started to do the lipo part, my patients just couldn't take it.  The many nail scratches on the ceiling of my OR are testimony to that.

   

if ever a subject deserved humor, it was gyne