The trend in cosmetic surgery has been to offer the patient less invasiveness, less downtime, with less pain. Some practitioners have decided to push this concept into the area of breast augmentation surgery. The New York Times recently published an article that put the spotlight on a doctor in Texas who does his breast augmentation surgery with the patient wide awake on local anethesia. This is not a fluke — it is a bonafide trend that appears to be going on across the US. My guess is that most plastic surgeons wouldn’t begin to try this, but the fact that “some 100 doctors across the nation” are doing it, according to the article, makes it a trend worth following. Awake for Breast Implants? If You Wish:
Dr. Robert L. True of Colleyville, Tex… advocate[s] local anesthesia and sedation for aesthetic surgeries like breast augmentations.
“They are talking to me the entire time,” Dr. True, an obstetrician and gynecologist by training, said of the 75 patients whose breasts he has enlarged in his accredited facility. Once the new implants are in, his patients are propped up on the operating table, look in a mirror and have their say. “They like that little bit of autonomy,” he said.
A lot of plastic surgeons consider it out of the question to do a breast augmentation without an anesthesiologist or nurse anesthetist on hand, partly because of the risk to the patient if something goes wrong. These doctors say they cannot do their best work — dissecting a pocket for an implant, then securing it — without total control.
But lately, a set of doctors, most of whom have not come up through plastic surgery, has been touting the awake option as a boon to patient choice and as a safer option than general anesthesia. Breast augmentation is often done in hospitals and accredited offices, but awake breast surgery is usually done in an office that might not have been vetted for safety by an accrediting organization.
“Problem is, doctors are doing large procedures on local with quote-unquote sedation to circumvent the need for accreditation,” said Dr. Lawrence S. Reed, the president of the American Association for the Accreditation of Ambulatory Surgery Facilities.
The article is a bit of a jaw-dropper, implicitly damning all those gynecologists, podiatrists, and other subspecialists who do the 2-week cosmetic surgery course and — bam! — they are suddenly offering not just fillers and injectables but full-blown surgical procedures. The article also gets real good when actual plastic surgeons pipe up with their objections to this practice.
“Two-day courses, it’s just crazy,” said Dr. William P. Adams Jr., a plastic surgeon in Dallas who teaches residents at the University of Texas Southwestern Medical Center. “It took us six years to fully train plastic surgeons to do breast augmentation.” He said it was irresponsible to let fuzzy-headed patients choose their implants. “They don’t let people drive after a six-pack of beers,” said Dr. Adams, who is an investigator for Mentor and Allergan, makers of breast implants (and a consultant for Allergan). “How well will people choose an implant size after narcotics?”