The New York Times reported on a disturbing new technique for breast augmentation, which is being marketed as a better and safer choice by some unscrupulous medical practitioners – awake plastic surgery.

While almost all surgical cosmetic procedures are performed under general anesthesia, a small group of doctors are advertising awake plastic surgery as a safer alternative that gives patients more autonomy and control during surgery. One doctor even told the NY Times reporter that he sits his patients up during surgery to look at their new breasts so that they can say if they are happy with the implant size and placement.

There are several reasons why this is a bad idea. Here is the short list:

  • “Awake” Promoters Are NOT Plastic Surgeons
  • Office Procedure vs. Accredited Surgical Office/Hospital
  • Drug-Induced Medical Decisions
  • Risk of Overdose
  • No Dedicated Anesthesiologist

“Awake” Promoters Are NOT Plastic Surgeons

The doctors touting and performing surgical procedures using only local anesthesia are not plastic surgeons, but rather were trained in another specialty such as obstetrics and gynecology. Plastic surgeons undergo five to eight years of surgical training AFTER medical school and have their knowledge and skills verified by stringent board examinations.

The New York Times article says:

“Dr. Anil K. Gandhi, who performs both awake procedures at his office in Cerritos, Calif., said he had taught “more than 100 doctors” in two-day $7,000 seminars for the National Society of Cosmetic Physicians. His students are doctors who typically did their residencies in ob/gyn or family medicine and who take a weekend course (or two) to learn how to do aesthetic surgeries with local anesthesia and sedation.”

Two-day courses are shocking and scary for those of us who spent five or six years learning how to perform breast augmentation. I would think that patients, if told, would feel the same way.

Office Procedure vs. Accredited Surgical Office/Hospitals

The doctors who perform awake plastic surgeries like to say that they do it for the patients. They claim that local anesthesia is safer and that patients enjoy more control during surgery.

In reality, procedures that are performed under local anesthesia can be performed in a doctor’s office and don’t require an accredited surgical facility or hospital. So using local anesthesia circumvents the need for the doctors to qualify to perform surgery at an accredited and inspected location. Basically, it’s a short cut for people who wouldn’t be allowed to operate in a hospital.

Drug-Induced Medical Decisions

You wouldn’t normally go to the salon for a radically new hair cut or color after after drinking a bottle of vodka. So why make decisions about the size and shape of your breasts while under the influence of narcotics?

Risk of Overdose

Awake surgeries are usually performed by giving the patient an oral narcotic for sedation and then a liquid is pumped into the area of surgery called “tumescent,” which is a mixture of lidocaine (to numb) and epinephrine (to control bleeding). An overdose of tumescent can lead to seizures, irregular heartbeat, or worse. Overdose risks are obviously increased when there is no anesthesiologist to monitor the patient, which leads me to my last point.

No Dedicated Anesthesiologist

Board certified plastic surgeons usually perform surgeries in an accredited operating room with an anesthesiologist who is responsible for monitoring the patient’s vital signs and ensuring that the patient is given an optimal amount (not too much, not too little) of anesthesia.

Most plastic surgeons want to focus on doing their best surgical work, which is nearly impossible to do if your focus is split between surgical technique and monitoring the patient at the same time. It also puts the patient at more risk if something goes wrong.

Promoting breast augmentations (and even tummy tucks) as procedures that you can get under local anesthesia seems to downplay the seriousness of these major surgeries. Until regulations are put in place to prevent untrained doctors from practicing in areas outside their training, I hope that patients do their homework and make informed decisions about who is doing their surgery and how.


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