Thursday, December 10, 2009

I'm afraid of the "awake" method good for me?

by Robert N. Young, M.D.
Board Certified Plastic Surgeon

We've seen a new trend in Cosmetic Plastic Surgery...promotions of "Awake Breast Augmentations".  It is talked about as something new, but in actuality, surgeries performed under "local anesthesia", or "twilight anesthesia" have been around for many years.  Whether it is a good choice for patients is being hotly debated.

Because Breast Augmentation has become such a popular procedure, and is more readily talked about by society, some feel it has become somewhat frivolized.  It is easy to forget that this is still a major surgical procedure. While endoscopic (minimal incision) techniques have made the surgery less invasive and easier to recover from, the procedure is best done under general anesthesia with a Board Certified Anesthesiologist. "Twilight anesthesia" can be dangerous without an anesthesiologist present.

There is quite a bit of debate recently about practitioners who are advertising "awake" surgeries.  These are usually performed by physicians who are not Board Certified Plastic Surgeons, and may not even be Plastic Surgeons at all.  Sometimes they are Dermatologists, General Surgeons, or even Family Practitioners who elect to perform the surgery under local anesthesia because they do not have  privileges in a hospital or certified surgery center to perform those procedures. In my Surgery Center, all anesthesia is administered and monitored by Board Certified Anesthesiologists who are experienced in Cosmetic Plastic Surgery.  I feel this is best for my patients, and myself, as it allows me to concentrate on my area of expertise, which is the surgery itself.

My Surgery Center is fully certified by the AAAASF and meets strict standards to perform surgical procedures. Sure, the surgery costs a little more, but it is worth having the extra standards and safety factors. That's why doctors are credentialed and surgery centers are certified. If we didn't adhere to these standards we would be cheaper also. So when you get a fee quote that is cheaper because it is under local anesthesia in an office back room, be careful of what you are asking for.

Board certification by an ABMS member board provides assurance of a physician’s expertise in a particular specialty and/or subspecialty of practice. Professional organizations, such as the American Society of Plastic Surgeons (ASPS), the American Society for Aesthetic Plastic Surgery (ASAPS) require that members be Board Certified within their specialty.

Some advertisements even go so far as to state that you'll be awake enough during your procedure to pick the size of your breast implants (this would only be possible with saline implants which are inserted and then filled to the desired size) during your surgical procedure itself!  If you have had sedation you are going to feel woozy and wobbly.  I don't think you would be coherent enough to make this selection during surgery!

We recommend that you ask questions that will ensure that you are well informed concerning the qualifications and experience of your surgeon and the types of anesthesia that you are offered.  Here are questions generally recommended:

  • Are you Board Certified? 
  • If so, what specialty board?
  • Are you licensed to practice surgery in this state?
  • How many breast augmentation surgeries do you perform each year?
  • How many years have you performed breast implant procedures?
  • Where is my procedure performed?  
  • Is the surgical facility accredited?
  • Who administers anesthesia during my surgery?
  • Is the person who administers my anesthesia Board Certified in this specialty? 
  • What are my options for anesthesia?

When you come in for a consultation visit with me, I will make recommendations based on my extensive experience as first a reconstructive and then cosmetic plastic surgeon. I invite you to ask questions regarding various surgical methods, anesthesia, recovery and any other questions you may have so that you can make an informed decision about your surgery.  You may contact my office at 210-496-BODY (496-2639) or e-mail me at

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