Awake or Under?

[Jacobi]

I have the surgery end of this month. I've been thinking about the option to be awake for the procedure with local anaesthetic. I've been told that the aftermath of general anaesthetic is a bit of a rough bounce back (prolonged grogginess, lethargy, fatigue etc), and I'm relatively unafraid of the surgery itself.

Does anyone have any input on this? What are the drawbacks of either choice?



Thanks,

Jacobi

[cbn21]

I think it really depends on the severity of your condition (ie how much gland they have to remove and if the surgeon also has to do any Lipo)

[Dr. Elliot Jacobs]

Local anesthesia (totally awake) would possibly work if you have a very small amount of tissue directly under the areola.  IMHO, if you have anything more than that, you would need IV sedation (which I used 99% of the time) or general anesthesia.  If you have more tissue, it will usually require liposuction plus gland excision, both of which would require deeper anesthesia.

My question to you:  hopefully, this will be a once in a lifetime operation.  Isn't it best to be kind to yourself and make the procedure as comfortable as possible, even if there is some additional cost??

Dr Jacobs

[Jacobi]

Dr. Jacobs:

Certainly, I do want the procedure to be as comfortable as possible, which is precisely the reason I am considering going with a less intensive option for anaesthesia. I had a conversation with my mother about anaesthesia, and she related to me concerns about the after-effects of general anaesthetic out of her experience with it after having a cesarian; it took her days to recover from the anaesthetic itself, and my own tendency is to avoid medicinal substances whenever possible.

My doctor called mine a "mild to moderate" case of gyno, and said he would utilize both lypo and gland excision.

I'm a layman in this regard, so please forgive my ignorance, but would using local anaesthetic only for such a procedure make the operation itself painful to any great degree?

Obviously, I'll be discussing this point with my doctor at our next appointment, but your input would be greatly appreciated.

[Dr. Elliot Jacobs]

As previous stated, local anesthetic works for very small, concentrated tissue directly under the areola.  Once you start to use lipo (in addition to gland excision), local anesthetics fail to cover the pain adequately.  It can be anywhere from really bad to excruciating, depending on how aggressive the lipo is done.  The problem is that some docs use local anesthetic and do lipo only to the point of pain -- and then they stop.  In reality, more lipo is usually needed to get the job done correctly.

I have had cases similar to that described above.  The lipo was inadequate -- and so the patient needed a revision.  But doing revisions are more difficult because of the added scar tissue from the prior (inadequate) lipo.

Dr Jacobs

[Jacobi]

^ Ok, from what you have told me, it seems that going under is probably the best option. Hopefully, my own doctor will corroborate this.

Thank you for your help, Dr Jacobs.