Excision under local anesthesia?

[G-Man99]

Hi everyone,

I would like to know if it's possible to have excision surgery under local only? Do some of you had excision under local? Is there something that make this impossible?

Thanks.

[Grandpa Bambu]

Yes, you can have excision done with a local...

GB

[G-Man99]

Yes, you can have excision done with a local...

GB

ok, thanks.

I have a consultation with a Dr in Montreal next week. His secretary answered to some of my questions by e-mial and she told me that most surgery are performed under general. There's no way I'm going to do this twice (I,ve had a first surgery with Fielding with very average results) under general, so I want to do it under local. But I'm wondering what are the reasons a surgeon wouldn't accept to do this under local anesthesia? I have a minor/moderate case (let's say that I need excision on my left and maybe both lipo and excision on the right side).

[Pacifico]

I asked Dr. Delgado in California about this (a highly respected specialist).  He said he felt he could not do the surgery as well under local because too much blood flows out.  Also he said if your surgeon needs more time to make things perfect local may wear off fast and not allow the surgeon enough time to finish the job.  The risks of general have all but dissipated with modern medicine. 

Just my two cents, as I had the same concern.

[Grandpa Bambu]

I asked Dr. Delgado in California about this (a highly respected specialist).  He said he felt he could not do the surgery as well under local because too much blood flows out.

Hmmm, that's odd. I have a video of a PS performing a complete Gynecomastic Reduction (excision) and there was very little blood loss...

Every doc has their preferred methods though... 

GB

[Pacifico]

Yeah, I saw one as well, but maybe the doc also injected something to restrict blood flow as well, but for whatever reason those were his feelings (or at least how I understood them).

[Dr. Elliot Jacobs]

I have no objection do doing a very small gyne under local anesthesia initially.  The local anesthetic injected routinely also contains small amounts of epinephrine (adrenaline), which tightens the blood vessels and reduces blood flow in the area, thereby reducing bleeding during surgery.

My main reluctance to do any secondary surgery under local anesthetic (rather than my preferred "twilight sleep" anesthesia, which is not general anesthesia) is that the local anesthetic doesn't penetrate all the tissues evenly.  Why?  After any surgery, your body will heal with scar tissue.  That scar tissue is present not only where the surgeon made his incision but everywhere under the skin that the surgeon worked.  This can be a very broad area.  Think of scar tissue as a barrier.  It doesn't allow for local anesthetic injected (for a revision operation, for example) to spread evenly and thoroughly throughout the tissues.  The result is uneven anesthesia which can be translated into "pain" for the patient.

My best suggestion for any revision:  twilight anesthesia with local anesthesia.

Dr Jacobs

[Grandpa Bambu]

My main reluctance to do any secondary surgery under local anesthetic (rather than my preferred "twilight sleep" anesthesia, which is not general anesthesia) is that the local anesthetic doesn't penetrate all the tissues evenly.  Why?  After any surgery, your body will heal with scar tissue.  That scar tissue is present not only where the surgeon made his incision but everywhere under the skin that the surgeon worked.  This can be a very broad area.  Think of scar tissue as a barrier.  It doesn't allow for local anesthetic injected (for a revision operation, for example) to spread evenly and thoroughly throughout the tissues.  The result is uneven anesthesia which can be translated into "pain" for the patient.

My best suggestion for any revision:  twilight anesthesia with local anesthesia.

Dr Jacobs

Thanks for the info Dr. Jacobs!

GB