Breast augmentation under local anesthesia. Breast augmentation under local anesthesia Breast augmentation surgery without anesthesia

Our portal receives many letters with questions about anesthesia, as an integral part of any operation. An experienced anesthesiologist-resuscitator of the highest category Bakaushin Mark Vladimirovi agreed to answer them, who has extensive experience in providing anesthesia in abdominal surgery, cardiac surgery, neurosurgery, orthopedics and traumatology, gynecology, as well as surgical dentistry, maxillofacial and plastic surgery; management of resuscitation patients in the intensive care unit. He is proficient in all types of modern anesthesiology.

The doctor also answers new questions on our forum in the appropriate section. If you did not find the answer to your question, feel free to ask it on the forum or at the bottom of this article in the comments.

Mark Vladimirovich, a member of the Plastic Club, sent us the following question: “I heard that one of the complications of general anesthesia is hair loss on the head. I already don’t have too much hair on my head, and if they start to fall out, it will be ugly. I am planning an abdominoplasty, and it is performed under general anesthesia. How to be? Cancel operation? Or are there preventive measures?

Another horror story about harmful anesthesia, in the era of the use of chloroform, ether and other poisons, perhaps not only hair fell out, it was about survival in principle. Currently, such drugs have long been taken out of production, and modern drugs are non-toxic, hypoallergenic and devoid of many side effects, they are also used in pediatric anesthesiology, both in economically developed countries and in others. It is hard to imagine that people in the III millennium, who are going to fly to Mars, continue to poison themselves with some kind of poison, and even more so their children. It is still unknown what we eat, drink and what we breathe every day. However, if you are in doubt, for abdominoplasty, the method of choice is epidural anesthesia, in which an anesthetic is used for local anesthesia.

Thanks, but here's another problem: “Hello! In the near future I want to contact a plastic surgeon about breast augmentation. For about 5 years I have been diagnosed with hepatitis C, in connection with which I have already been denied surgery twice. The motive is a high risk of the effect of anesthesia on the liver affected by inflammation. Is it possible to have an operation, are the refusals legal, what kind of anesthesia would be the best in my case?

If chronic hepatitis is not in the active phase, ie. in the stage of stable remission, as evidenced by the level of liver enzymes (AST, ALT, alkaline phosphatase, bilirubin), indicators of the blood coagulation system (APTT, INR, prothrombin, etc.), blood albumin, as well as ultrasound, CT of the liver - then surgery possible. At the same time, it is not advisable to use drugs that even potentially have a hepatotoxic effect (halothane, enflurane). The method of choice is combined anesthesia (V\V and local), inhalation anesthesia (sevoran, isoflurane) or epidural anesthesia at the thoracic level.

“Three months ago my aunt had plastic surgery under general anesthesia. A few hours after the end of the operation, her health deteriorated, the doctors diagnosed her with a stroke. Now she walks only with the help of a stick, she speaks indistinctly. The most unpleasant thing is that doctors do not admit their mistake - the surgeon nods at the anesthesiologist, the anesthesiologist - at the surgeon. Who is responsible (and is it) for such an outcome of the operation? Could this complication have been prevented? “This is a question of very concrete practical importance.

According to existing legislation, the surgeon and the anesthesiologist are equally responsible to the patient. But in practice: everything that is connected with the health and life of the patient is an anesthesiologist, that with a specific operated organ is a surgeon. So it turns out that the anesthesiologist-resuscitator is under attack. It is necessary to specifically deal with what happened, to study the anesthesia card, which is a legal document, whether the anesthesia was adequate, what was the hemodynamics (high rises or hypotension, their duration, etc.), whether there was hypoxia, hypercapnia, etc. On the other hand, whether prevention of thromboembolic complications was carried out in the preoperative period, whether hemostasis was carefully performed by the surgeon (during operations in the cervical region, hematomas can be fatal), etc. It is obvious that no one is interested in an unfavorable outcome.

Another question about risks: “What is the risk of ASA anesthesia? Is it determined when planning plastic surgery? Who determines by what parameters?

In the 1940s, the American Society of Anesthesiologists (ASA) tried to collect and systematize statistical data in order to develop an approach to predicting the risk of perioperative complications; it was proposed to unify the assessment of the patient's condition before surgery. As a result, the ASA has adopted a classification of the patient's condition, according to which the patient is assigned to one of five classes (assessment of the physical status of the patient).

Classification according to ASA (American Society of Anesthesiologists):

• Class 1 - patients without systemic diseases.
• Class 2 - patients with a compensated systemic disease that does not impose significant restrictions on physical and social activity.
• Class 3 - patients with a serious systemic disease that limits physical and social activity, but can be compensated by treatment.
• Class 4 - patients with decompensated disease requiring constant medication.
• Class 5 - patients who can die within a day, regardless of whether they receive medical assistance or not.

If the operation is performed for emergency indications, the letter “E” is added to the name of the corresponding class.

Assessment of the patient's physical condition on the ASA scale provides more specific information to the anesthesiologist and more accurately aims him at preventing possible complications during surgery. The decision is made by the anesthesiologist after consulting a particular patient. Obviously, most patients in plastic surgery fall into the first two classes.

A very common problem today is smoking. "Does the fact that I smoke affect the choice of the method of anesthesia and the course of the operation? Should I quit abruptly or will it only make it worse?"

Carbon monoxide (CO), which is part of cigarette smoke, reduces the delivery of oxygen to tissues. Nicotine leads to an increase in heart rate and can cause peripheral vasoconstriction, when organs such as the intestines, muscles, skin (that is, the least important) are turned off from the bloodstream. Within 12-24 hours of quitting smoking, CO and nicotine levels return to normal. Drainage function of the bronchi improves within 2-3 days, and sputum production decreases to normal levels in about 2 weeks.

At least 8 weeks of abstinence from smoking is necessary to reduce the risk of respiratory complications to the level of non-smokers. Smokers who do not want to stop smoking before surgery, however, it will be useful to refrain from smoking at least 12 hours before surgery. During this time, the effects of nicotine (activation of the sympathoadrenal system with increased resistance of the coronary vessels) will smooth out. The level of carboxyhemoglobin (COHb), which in heavy smokers can reach 5-15%, will also decrease. If the operation is planned on the lower half of the body, then the method of choice is epidural anesthesia, without unnecessary manipulations in the oropharynx and upper respiratory tract.

To date, there is a fairly large selection among the types of anesthesia. The universally recognized classification is the following:

1. General anesthesia (narcosis);

2. Regional anesthesia: spinal anesthesia, epidural anesthesia, conduction anesthesia;

3. Local anesthesia;

There are several other anesthesia techniques. These are such as:

4. Sedation. Sedation, some experts, distinguish in a separate class of varieties of anesthesia;

5. Intravenous anesthesia;

6. Mask anesthesia;

7. Endotracheal anesthesia;

8. Inhalation anesthesia.

As for intravenous, mask, endotracheal and inhalation anesthesia, opinions are divided here. Some experts also classify these types of anesthesia in separate classes, while others classify them as a group of general anesthesia.

Choice of anesthesia

The choice of anesthesia depends on several factors:

• Surgeon preference;
• Individual characteristics of the patient;
• Technical features of the operation.

General anesthesia

Breast augmentation, reduction and lift operations are usually performed under general anesthesia. Taking into account the fact that mammoplasty surgery is performed on fairly young and healthy patients, general anesthesia is well tolerated without causing serious complications.

Combined anesthesia

With poor tolerance of general anesthesia, combined anesthesia is used: a combination of sedatives and local anesthesia. The advantage of using combined anesthesia: sedation and local anesthesia, is a faster awakening of the patient after anesthesia, a lower incidence of possible complications: nausea and vomiting.

Local anesthesia

Local anesthesia is used in the case of a small operation, when there are contraindications to general anesthesia, or when the patient is in a serious condition.

Adverse reactions of anesthesia

Nausea:

A very common reaction after anesthesia, occurring in 30% of cases. characteristic of general anesthesia.

Nausea Prevention:

• During the first hours after the operation, sudden movements, increased activity should be avoided - getting out of bed;
• Do not drink water and food immediately after the operation;
• Do not tolerate severe pain, which can cause nausea. Take painkillers promptly.

Sore throat:

Sore throat, as well as dryness, are not complications, but the consequences of anesthesia. The severity of pain sensations can be different: from mild discomfort to acute pain that makes it difficult to speak and swallow. Such symptoms may disappear within a few hours after surgery, or be of a more protracted nature.

Shiver:

Trembling is also a consequence, not a complication of anesthesia. The resulting trembling causes great discomfort for the patient, but does not pose any danger to his body. Typically, the shiver lasts about 20-30 minutes. To reduce the likelihood of developing shivering, you should keep your body warm before surgery.

Dizziness and faintness:

Dizziness and lightheadedness can be caused by low blood pressure or dehydration, which are not uncommon after surgery.

Headache:

There are many reasons for headaches:

• drugs used for anesthesia;
• operation;
• dehydration;
• patient anxiety.

Most often, the headache goes away on its own or after taking painkillers.

Itching is an adverse reaction to drugs used for anesthesia (eg, morphine). In addition, an allergic reaction can cause itching, so you should immediately inform your doctor about the appearance of itching.

Pain in the back and lower back:

An invariable position on a solid operating table for quite a long time is often the cause of lower back pain.

Confusion of consciousness:

Some patients in the early postoperative period experience memory impairment, behavioral disorders, confusion. All these phenomena pass independently.

Awakening during anesthesia:

A very rare anesthetic complication, as a result of which the patient wakes up during the operation, consciousness returns to him. Already in the postoperative period, the patient can remember some episodes of the operation.

Serious allergic reaction (anaphylaxis):

A severe allergic reaction (anaphylaxis) can be caused by a large number of medications that are used during surgery and the early postoperative period. The incidence of anaphylaxis is not high and is 1 in 15,000 anesthesias. Anesthesiologists successfully diagnose and treat this complication.

Eye injury during general anesthesia:

A very rare complication involving damage to the cornea. The reason for this is not completely closed eyelids during anesthesia, as a result of which the cornea dries up and the eyelid “sticks” to it from the inside. When the eyes are opened, the cornea is damaged. The pathology does not affect the patient's visual acuity in any way, but can lead to the appearance of a dark or blurry point on the damaged eyes.

Often, women planning breast augmentation mammoplasty ask themselves the question: is breast augmentation possible under local anesthesia? The answer to this question is clear: no. Breast augmentation under local anesthesia is not performed, endoprosthesis with breast implants necessarily requires general anesthesia, which is usually done using combined endotracheal anesthesia. The patient's respiratory processes are provided by a specialized anesthesia and respiratory apparatus, which immerses the woman in a deep sleep and ensures the safe course of the operation. This method of anesthesia is the most effective and safe for augmentation mammoplasty, it meets the modern requirements of surgery.

Breast augmentation under local anesthesia

Why is general anesthesia needed for breast augmentation, and not local anesthesia, in which the woman is conscious? Endoprosthetics with breast implants lasts 1-2 hours, that is, it is a serious and full-fledged surgical operation, which involves deep incisions and manipulations with the internal tissues of the breast.

General anesthesia in augmentation mammoplasty is a traditional, well-established and well-established technique. Preliminary consultation with an anesthesiologist responsible for adequate anesthesia during the operation ensures the optimal course of mammoplasty with minimal psychotraumatic consequences for the patient. Before the operation, the anesthesiologist carefully examines the patient's health, conducts a conversation with her and analyzes the results of the preoperative examination. Such a meticulous and professional approach ensures maximum safety for the woman during the operation and minimal consequences from general anesthesia.

Theoretically, breast augmentation mammoplasty or breast augmentation under local anesthesia can still be performed, but this will be associated with significant pain and extreme psychological stress on the patient. The stress and psychological discomfort that she will experience being conscious for a long time on the operating table is much more harmful to her health than modern general anesthesia.

Where do women get this desire to perform breast augmentation under local anesthesia, because the price of a bust augmentation operation does not depend much on the type of anesthesia used? It's just that many ladies mistakenly believe that general anesthesia is extremely harmful, so local anesthesia is preferable. This opinion is based on information from many years ago, when general anesthesia techniques were much less advanced than at present. Modern pharmacology and anesthesiology have come a long way. This makes it possible to minimize the undesirable effect of general anesthesia on the body and ensure a favorable course of rehabilitation after breast augmentation.

Types of breast plastic surgery performed under local anesthesia:

• Breast lift surgery can be performed under general or local anesthesia.
• Surgery to correct the nipple and areola, much more often resort to local anesthesia, sometimes sedation is used.
• Operations to increase the volume of the bust with the help of implants can also, if necessary, be performed under local anesthesia.

The use of this method requires high professionalism and an individual approach to each patient from the doctor.

Breast augmentation under general anesthesia

With breast augmentation and reduction, general anesthesia is usually used, and if there are contraindications, they resort to local anesthesia. Local anesthesia is used infrequently, since extensive surgery will require quite a lot of drugs, which can cause convulsions and arrhythmias.

Most surgeons prefer to operate under general anesthesia, this allows them to concentrate on the operation as much as possible, and not on local anesthesia. The process of breast augmentation under general anesthesia makes the procedure for inserting implants much easier. General anesthesia is easily accepted by most patients, because bust resizing surgery is usually performed by young and healthy women who do not suffer from serious illnesses.

Is the patient's fear of anesthesia justified?

Often, patients are afraid of anesthesia even more than, in fact, the operation and its results. People are afraid of pain and uncertainty, an unpleasant feeling when they wake up. Many are haunted by the fear of waking up during the operation or, on the contrary, not waking up after it.

These fears are completely unfounded. The anesthesiologist monitors the vital signs at all times, carefully observing the course of the operation. It takes into account which stage of the procedure the surgeon is in and accordingly decides whether to continue the process of providing sleep.

The fear of death, which quite often haunts patients, also has no serious grounds. In plastic surgery, operations are performed on the integumentary tissues, without touching the internal organs, and with a reasonable approach, they do not carry a risk to life.

The patient is responsible for keeping physicians informed about chronic diseases and medications. After all, any nuance that a person did not mention or forgot about can have a significant impact on the result.

The information on the site has been personally verified by plastic surgeon Osin Maxim Aleksandrovich, if you have any additional questions, please call the phone number listed on the site.

Mammoplasty is a type of plastic surgery aimed at achieving an increase in the size of the mammary glands. In order to give the bust a lush volume, implants are implanted in the pectoral muscle tissue: silicone inserts or medical products filled with saline. The type of anesthesia for mammoplasty is chosen after an objective analysis of the client's health status, risk assessment from the use of anesthetics, technical nuances of the upcoming surgical intervention, patient and doctor preferences. To date, the following options for anesthesia during surgery are possible: breast augmentation under local anesthesia, a combination of local anesthetics and sedatives, or under general anesthesia.

Some surgeons prefer to perform mammoplasty under anesthesia. Due to the introduction of the patient into a medical sleep, the complete immobility of the operated person is ensured. This greatly facilitates the work of doctors in installing implants and makes it possible to concentrate maximum efforts on the operation itself, and not on controlling the course of local anesthesia.

The use of modern drugs for general anesthesia provides a fairly comfortable state of health for completely healthy people, however, this method is not resorted to in situations where there is a history of chronic somatic pathologies. The procedure for breast augmentation under local anesthesia is the only way to guarantee the absence of any dangerous complications that are likely after the use of strong sedatives with general anesthesia. For this reason, most plastic surgeons prefer breast augmentation under local anesthesia with additional sedation.

Obvious advantages of the complex use of anesthetic drugs and medicines that have muscle relaxant and sedative effects:

• the ability to maintain consciousness and wakefulness during manipulation;
• rapid recovery of the patient after surgery;
• minimal risk of developing nausea and vomiting in the rehabilitation period;
• less risk of manifestations of side effects of anesthetics (due to the slow entry of active elements into the bloodstream).

The disadvantage of the combined technique: local anesthesia and sedation during breast augmentation is a longer duration of the operation itself due to the relatively slow onset of the analgesic effect after local administration of drugs.

A limitation in carrying out breast augmentation procedures under local anesthesia is the vast field of surgical work, which requires much longer to cover. Such a forced long duration of breast augmentation surgery requires the introduction of high doses of local anesthesia, which is not always justified and safe for human health.

The third option for anesthesia during mammoplasty is the injection of a locally acting anesthetic into the operated area. This method is resorted to in cases where the site of the upcoming intervention of the surgeon is small in area. Also, breast augmentation surgery under local anesthesia is advisable if contraindications to the use of general anesthesia are established or when the patient has previously recorded cases of allergic reactions to specific medications.

Breast augmentation under local anesthesia is not performed in cases where it is necessary to use drugs in large dosages, which carries a potential threat of toxic reactions: arrhythmias, seizures, loss of consciousness. The first choice for mammoplasty is the safest drugs: lidocaine, novocaine bupivacaine.

Attention! The presence of serious pathologies in a person makes breast augmentation both under local anesthesia and under general anesthesia a deadly manipulation, so before the operation it is worth weighing the pros and cons. The only guarantee of the safety of surgical intervention is mammoplasty by experienced plastic surgeons and qualified anesthesiologists in a certified clinic. Compliance with the international protocol on the use of anesthetics and the implementation of all precautions is the best protection for a woman.

You can learn about how mammoplasty works from the video

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