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Is twilight anesthesia safe and pain free?

Q:

Is twilight anesthesia safe and pain free when used to explant and replace breast implants?

A:

Twilight anesthesia is safe when used to explant and replace breast implants. It does not make the procedure painless. That job is done by a local anesthetic agent that must be injected. You will feel the injections, but the conscious sedation will make it bearable and where you probably will not remember them. This is a major procedure and I would advise general anesthesia. If your surgeon cannot do it under general anesthesia, then he/she is not doing the procedure in a certified facility and I would strongly suggest switching surgeons.

Robert T. Buchanan, M.D. - View Other Answers by this Doctor
Highlands, NC
Practice Website

A:

 

The answer to your question would be dependent upon the anesthesia provider, your surgeon and the extent of surgery required in your case.   From Wikipedia: Twilight anesthesia is commonly known as I.V. sedation and calls for an easy awakening and speedy recovery time by the patient (http://en.wikipedia.org/wiki/Twilight_anesthesia). It has recently been popularized by the Twlight Movie Series. IV sedation combined with a local anesthetic can be very effective in minimally invasive/ painful surgery.

 Some anesthesia providers provide excellent IV sedation and others are not so good. If your surgeon has no anesthesia provider then, he probably is managing your anesthesia while operating upon you. This could be like asking a pilot to fly and serve the passengers dinner/ drinks during a flight. Things could be fine on autopilot but, lets hope there is no turbulence or bad weather. Many providers prefer IV sedation as it much much cheaper to provide than general anesthesia. Very expensive supplies, equipment and facility building/ safety requirements are required to be able to administer a general anesthetic to a patient.

 If you have old silicone implants that are being removed and replaced this could be a rather extensive and painful procedure if a thick capsule has formed around the implants. Many plastic surgery practitioners would prefer a general anesthetic for such an extensive procedure. If it is the simple removal and replacement of prior saline implants a less extensive procedure may be required. 

 We prefer to have a separate provider to administer anesthesia for our patients and let them determine the best anesthetic after evaluating our patients. Many of our procedures are extensive and, therefore IV sedation would usually provide inadequate anesthesia during these surgical procedures. The overall goal should be to provide a pleasant experience as possible for all involved. Consider discussing your concerns and these issues with your surgeon. If your issues are not adequately addressed than consider a consult with one of the many members of the ASAPS. Best,

 

Gary R Culbertson, MD, FACS

Gary R. Culbertson, MD, FACS - View Other Answers by this Doctor
Sumter, SC
Practice Website

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