Local anesthesia gyno surgery pro and cons

[ducky]

What is your opinion on using local anesthesia for the procedure?


I know its significantly cheaper for the patient if it is done with local anesthesia. But, if its cheaper, why isn't it always done with local? Is general advantageous somehow? Depend on the experience level of the physician/where they were trained? Something else?

Thanks

[Dr. Elliot Jacobs]

If you wish to have a thorough and complete removal of your gyne and appropriate sculpting of the surrounding tissues, then local anesthesia is simply not sufficient.  I use local anesthesia and sedation ("twilight sleep" or conscious sedation) administered by an anesthesiologist for my cases -- and it works very well.

I have had some patients come to see me for revision after they had surgery by a NY "removed doctor" -- who likes to do many procedures under local anesthesia.  Not only did they have great pain during the surgery, but the surgery could not be done properly because they were squirming so much. Hence the need for a revision.

Do yourself a favor -- if you want your gyne done right, then do it the right way.  Consult a gyne specialist, have the surgery done under sedation or general anesthesia and pay for it.  If it is done properly, you will have the results for a lifetime -- and you will quickly forget the original fee.

Dr Jacobs

[DrPensler]

I most often ( 98% ) use what is referred to as conscious sedation, which is neither general anesthesia or local.It is typically what is done during a colonoscopy,where drugs are given through an intravenous line while monitoring the patient.This has worked well in my practice with well over a thousand cases.I do have an interesting subset of patients ,navy seals,special forces and some marines who prefer to be awake and I have done them under local anesthesia without a problem.They are a bit special to put it mildly. I always start an iv in patients even those who prefer to be awake so that the patient can change his mind during the procedure. Also all the patients have nothing to eat after midnight. As you know there is a wide spectrum of gynecomastia and without knowing any of the specifics of your case it is impossible to comment further.
I always tell patients that surgery is tough but its tougher to perform a great operation on a moving target.

[Dr. Schuster]

There are several options for anesthesia when having gynecomastia surgery. The decisions should be based on the severity of the problem, the extent of the surgery to fix the problem and the tolerance of the patient. I most cases I perform the surgery under a twilight type of anesthesia. I think that it makes it more comfortable and quicker for the patient. A lot of numbing medicine is placed in the form of tumescent solution and it is much easier to put it in when the patient is temporarily "knocked out". Then the patient can just snooze through the whole thing. I have performed small revisions under just local without any problem. Some patients are so nervous that I think it's better to simply have a general anesthetic. At the end of the day it also comes down to having good qualified anesthesia services.