Awake Breast Augmentation?

This is a new one for me—How about “Awake Breast Augmentation?”  Yes, there are some sites advertising that you can be “wide awake” for your breast augmentation surgery.  By “awake”, they mean not done with any general or IV anesthesia.  The procedure is done under local anesthesia with the patient taking medications by mouth for sedation.   One of the sites even has a video on their site demonstrating how the patient is able to “participate” in the decision making process.  The video shows the patient looking at her breasts in a mirror across the room with the incisions open.  The doctor is shown asking the patient if she likes her size and then encouraging her to increase her size.  The patient, who looks like she has had ten stiff margaritas, of course agrees to increase her size.  I was sitting next to a plastic surgeon who also happens to be an attorney when I viewed this video and I have to tell you, he was stunned.  As he put it, that patient had no more ability to make an informed decision about her implant size than she did the ability to drive after all of the medications she had received.   The surgeon “pushing” the patient to go beyond the original selected size was very disturbing.  The good news, he wasn’t a plastic surgeon or a member of the American Society of Plastic Surgeons or the American Society for Aesthetic Plastic Surgery.  The only credit listed in the video was that the surgeon was a “cosmetic surgeon.”

Sometimes something that sounds like a good idea isn’t and this is one of them.  Patients should never be placed into a position that requires them to make complex decisions while under the influence of medications.  The gold standard still is consultation and informed consent prior to any medications being given to the patient.  The video for this “wide awake” breast augmentation procedure demonstrates again why this still is the correct way to treat patients.

Herluf Lund MD

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