Anesthesia for Surgery

[zado611]

Do surgeons use local or "twilight" for most surgeries?

[DrBermant]

Do surgeons use local or "twilight" for most surgeries?

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 heavy 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

[Dr. Elliot Jacobs]

There are three types of anesthesia for any operation.

1. Local anesthesia:  the surgeon (or dentist, for example) injects numbing medicine in and around the area to be worked on.  You initially feel the needle prick -- then everything becomes numb.  The doctor can do his work and there will be no pain -- although you may be aware of some pushing and pulling sensations. You will be totally awake.  This type of anesthesia is useful for very small gyne or work done on the nipple/areolas only.

2. IV (intra-venous) sedation (sometimes called "twilight sleep" and technically called "conscious sedation").  This is usually administered by a separate anesthesiologist (usually an MD, sometimes a nurse anesthetist) although some surgeons like to do this themselves (I usually don't recommend a surgeon doing both jobs).  You will be gently sleeping due to a mixture of medications -- with no pain and no awareness of anything. The surgeon can do his operation and you have absolutely no pain and no memory of it. Yet you wake up with no nausea, grogginess or hangover -- and are quite lucid from the moment you open your eyes.  I think this is the ideal type of anesthesia -- and I use it 99% of the time.

3. General Anesthesia:  you are "out", unconscious, with a tube in your throat and a machine breathing for you.  Some doctors prefer this and it is perfectly acceptable.  Wake-up is slower, there may be grogginess which may last up to 24 hours.  This anesthesia is useful and necessary for major gyne surgery which may include lateral chest fat, skin removal, nipple elevation, mastectomies, etc -- ie for surgery that will take several hours.

Dr Jacobs