Revision under local

[PaulSW]

Being new to this board I wondered if anyone had had an open revision under local.

I had my surgery (under arm incision) almost a year ago and have some scar tissue only on one side.

I have seen my PS who has said he is happy to revise the right side by using an aureole incision under local.

I am keen not to have a general and wondered if anyone had had this done and how it felt (panic strikes about the pain)

[Dr. Elliot Jacobs]

Obviously I haven't examined you, but would like to pose a question -- has your surgeon considered treatment of scar tissue with a series of Kenalog injections?

If he feels you are not a candidate for Kenalog, then I would recommend you consider something more than local anesthesia for the operation (ie either IV sedation or general anesthesia).  The reason is that local anesthesia is difficult to inject and it doesn't spread well in scar tissue.  Also, sometimes the operation is more extensive than the surgeon anticipates and then the need arises for more local anesthetic to be injected while you are already in discomfort.  It doesn't make for a pretty scenario. 

Dr Jacobs

[PaulSW]

I had heard Kenalog was quite risky and would like the lump 'removed'

Your experience of locals and surgery doesn't sound promising though what is a grade IV anesthetic?

[Dr. Elliot Jacobs]

I don't know who you spoke to but Kenalog, in the hands of an experienced physician, is an excellent treatment.

What I referred to is not grade IV (ie four) anesthesia but IV (as in intravenous) sedation anesthesia.

Dr Jacobs

[PaulSW]

Just to keep everyone updated.

I have had open revision (nipple incision) on the left side under local.

Dr Jacobs you were absolutely correct the local hurt more than the cutting and snipping with the scissors however the cauterization was even worse.

Did like the fact that I was awake and walked out of the hospital almost immediately, however, I didn't have a drain in because I asked not to then two days later had to have 30cc of blood etc. removed.

Would I have it done under local again. Defiantly.