My case was similar yours. Thin build, mostly enlarged gland tissue. I had lipo and excision. The doctor gave me the option to have the procedure done under local anesthesia. It saved me about $1500. He said he rarely gives his gyne patients this option, it wasn't something I asked, he made the suggestion. He assured me it would be a simple operation, so I took the offer. Now let me say this, the injection going into the nipple was EXTREMELY painful. I'm talking hand cringing, forced tears kinda pain, but only for the 2 minutes or so it took for the injection. The lipo was also somewhat uncomfortable. The excision was painless, just a little tingly. To me, the pain was definitely worth the money I saved. I almost liked being awake during the operation because I had an extremely spiritual moment of inner peace and joy, an overwhelming feeling of success and accomplishment that I will never forget my whole life. It's not like ur just wide awake, ur still really doped up.. After the operation there was no extra or excessive pain because it was done under local. I really was in no pain at all, and the recovery process was no different. The shot into the nipple was the only part that really hurt, having it done under local didn't make the operation more risky or anything. I barely even had any bruises. I'm almost four weeks post op and you can barely even tell I've had surgery, the location of the incisions blend in really well. The doctor told me today I no longer need to wear the compression binder, but I'm still going to wear it at night and at work just to be safe. My nipples are still pretty tender, he said this is normal. Anyways, If the doctor does not offer it to you, then he probably doesn't feel comfortable doing it, so it probably shouldn't be done. Also, the surgeon fee's I paid were half the amount of the averages you listed above, and so far I am very satisfied. I'd say it's definitely worth a little extra money for some added security of a good result, but at the same time, it's definitely worth doing some research and shopping around before you make any kind of decision.