Cosmetic Surgery Tips

Breast Augmentation Under Twilight

The Twilight Procedure is a minimally-invasive breast augmentation procedure that can give you the look you’ve always wanted. The procedure involves placing implants under the breast tissue, rather than over top of it, which reduces recovery time and risk of infection. In this blog post, we’ll discuss what to expect during and after a Twilight Breast Augmentation procedure.

What is the Twilight Procedure?

Dr. Stuart Linder created the Twilight Procedure, a minimally invasive breast augmentation procedure, in the 1990s. It involves placing implants under the breast tissue, rather than over top of it. This reduces recovery time and risk of infection. In this guide, we review the aspects of Breast Augmentation Under Twilight, how long are you under anesthesia for breast augmentation, are you intubated for breast augmentation, and iv sedation for breast augmentation.

During the procedure, your surgeon will make an incision on either side of your nipple or in front of your armpit (depending on whether or not you have had previous surgery). Once inside, he or she will place an implant beneath your breast tissue before closing up the incisions with stitches. You may also receive liposuction at this time to help give you a more symmetrical figure or remove excess fat from other parts of your body (such as hips).

Afterward, you may feel soreness or discomfort around your incision sites; however, most patients do not experience any long-term.

Breast Augmentation Under Twilight

Twilight Sedation vs. General Anaesthesia

For patients undergoing breast augmentation in Brisbane, there are a huge number of decisions to be made when it comes to all aspects of surgery. One important topic patients should understand before choosing a plastic surgeon is the huge distinction between general anaesthetic and twilight sedation. The difference between these two methods of sedation will have significant safety implications. It is also indicative of the quality of service and care provided by certain practitioners. In this blog post Brisbane plastic surgeon Dr. Philip Richardson and his team aim to explain the difference between general anaesthetic and twilight sedation, and help patients make more informed decisions with regard to their breast surgery, whether it be a breast augmentation, breast lift, breast reduction, or breast revision.

What is general anaesthetic?

General anaesthetic is a medically-induced state of unconsciousness that results in the loss of control of reflexes and the autonomic nervous system. General anaesthetic blocks the ability to feel pain or remember the surgical procedure. During a general anaesthetic patients have a breathing tube and ventilator to assist in respiratory function.

General anaesthetic is administered intravenously by a fully-qualified anaesthetist. An anaesthetist is a healthcare practitioner that will evaluate, monitor, and supervise the patient throughout the preoperative period. Anaesthetists play an important role in airway management, post-operative care, and resuscitation and life support in emergency situations. The role of the anaesthetist in patient safety is incredibly important.

Example of general anaesthesia

Who uses general anaesthetic?

General anaesthetic is most commonly used by plastic surgeons in fully-accredited hospital facilities. This is because plastic surgeons have the resources and privileges to operating out of such facilities. They also have the privileges to work alongside fully-qualified anaesthetists. Under-qualified cosmetic surgeons will often operate from their own private clinic, without an anaesthetic team. Thus, they are unable to administer general anaesthetic.

What are the risks of general anaesthetic?

As with all forms of sedation, general anaesthetic comes with risks. The most prominent risks associated with this form of sedation include post-operative nausea and vomiting, or physical injuries such as damage to teeth, a sore throat, or reactions to drugs administered for the anaesthesia. In extremely rare instances patients can lose their site or die due to the effects of general anaesthetic – but the risk is extremely low at 1 in 100,000.

Overall, general anaesthetic is safe, especially when administered by an experienced anaesthetist. At Brisbane Plastic & Cosmetic Surgery, Dr. Phil Richardson has been working alongside the same anaesthetic team for the past 18 years, and places the utmost trust in these highly-skilled professionals.

What is twilight sedation?

Twilight sedation is a completely different form of sedation. “Conscious sedation” is another term for this approach. In this instance, a small dose of general anaesthesia sedates the patient. The patient enters a relaxed, sleep-like state where they are still responsive and able to follow directions. Twilight sedation means patients remain easily aroused and responsive to tactile stimulation. The patient can breathe on their own, and the approach does not usually affect cardiovascular function. While this may sound like a safer, less daunting approach for patients, twilight sedation is a far riskier option. Plastic surgeons do not recommend twilight sedation for surgical breast procedures.

twilight sedation

Who uses twilight sedation?

The majority of practitioners that offer breast surgery under twilight sedation are cosmetic surgeons that are operating out of their own clinics. These clinics fail to meet the standards of the private and public hospital settings. As a result, they do not have the accreditation required to provide general anaesthetic. These practitioners often do not have access to the fully-qualified anaesthetic team. Thus, they opt for the alternative approach which is conscious sedation.

What are the risks of twilight sedation breast augmentation?

Twilight sedation has significant risks. The most prominent risk is anaesthesia toxicity which occurs as a reaction to excessive local anaesthesia. This adverse reaction can cause heart attacks, and the risk is amplified given that the patient is not having their operation in a hospital setting and likely without a qualified anaesthetist on site. The patient will have to transfer to the nearest hospital ICU which can be potentially fatal. There are also significant breathing risks due to the anaesthetic, in which case the patient must again transfer to a hospital. If there is not a qualified anaesthetist monitoring the patient throughout sedation, the surgeon must simultaneously monitor the patient while operating. This has obvious repercussions for both safety and surgical outcomes.

Can Breast Augmentation Be with Twilight Sedation?

While some minor procedures such as lesions, some X-Ray procedures, dental procedures. and medical examinations can be safely performed under twilight sedation, invasive surgeries such as breast augmentation or any other breast surgery should always be performed under general anaesthetic. An experienced anaesthetist should manage and monitor the patient to avoid complications. A fully-accredited hospital facility is where the procedure should take place for the safest outcome. It’s important to remember that twilight sedation is generally indicative of a lack of accreditation on the part of the practitioner to use the facilities needed for general anaesthetic, and is subsequently indicative of their level of accreditation and training compared to a plastic surgeon.

how long are you under anesthesia for breast augmentation

General anesthesia means fully asleep – you will have no realization that you are going to sleep, no awareness of what transpires during your surgery, no sensation of discomfort during surgery, no recollection of what went on during surgery and no recollection of waking up from surgery. Who could ask for anything more pleasant? Certainly, some people are fearful of general anesthesia, usually out of lack of understanding of what it entails. When performing breast augmentation, there are some distinct advantages to utilizing general anesthesia over other techniques. The following is a brief description of the differences between the three types of anesthesia:

General anesthesia – drugs are given intravenously to make you relaxed, all anxieties you may have will disappear, and you will slowly drift off to sleep. Once asleep, a breathing tube is gently placed through your windpipe through which oxygen and some anesthetic drugs in gas form are given to you. Your vital signs, oxygen and carbon dioxide levels are continually monitored for your safety. General anesthesia affords you the following: no perception of pain, no recollection of the period of time between when you go to sleep and when you wake up, muscle relaxation and a peaceful sleep. Your airway is protected via the breathing tube and the muscle relaxation is important to reduce post operative discomfort and facilitate the surgery (the muscles are not resisting the surgeon’s efforts). Overall, the anesthetic medications will be out of your system faster with general anesthesia than will intravenous sedation.

Local anesthesia – Medication is injected into the surgical site to make the tissues numb – so that the pain nerves in the tissues do not work. This will not afford you any degree of mental relaxation. For larger surgeries, it can be difficult to use local anesthesia because there are limitations as to how much of the local anesthetic drug you can receive before toxic doses are reached. This can pose a problem during surgery if the degree of numbing of the tissues is inadequate and more drug is required. There is also no muscle relaxation, which means that the surgeon will have to pull harder against your pectoralis muscle, resulting in more discomfort after surgery.

Local anesthesia + Sedation (oral or intravenous) – Local anesthesia is given as above, but also sedation is given to relax you. If sedation is given, you should be monitored by an anesthesiologist or nurse anesthetist as over sedation can cause you to stop breathing on your own. Proper monitoring would prevent this or at least allow immediate intervention should this be required. Sometimes if local + sedation is not working well (difficulty keeping the level of sedation at the right level), then the patient can be converted to general anesthesia. There is still no muscle relaxation with sedation. That requires special medication. Muscle relaxation means that none of your muscles are able to move, and while your pectoralis muscle will be nice and relaxed and not fighting the efforts of the surgeon, so will your breathing muscles be relaxed and not working, which is why general anesthesia is required when muscle relaxation is used.

are you intubated for breast augmentation

One of the most common questions regarding breast augmentation is “how much does it cost?” When you are looking to make a costly purchase of any kind, the cost is certainly an important factor to consider, but when your health and medical results are at stake, it shouldn’t be the only one. In fact, it should be far down the list, below patient safety and the quality of the results. Cheap surgery can end up being the most expensive procedure of all.

Patient safety

Breast augmentation is real surgery, and although the complication rates are low, they are much higher in the hands of someone who isn’t well-trained or who cuts corners by operating in an unaccredited facility. The most extreme is to get bargain surgery in another country without rigorous safety regulations.

Start by confirming that your surgeon is board-certified – not by just any board, but by the American Board of Plastic Surgery. This indicates that the surgeon has gone through rigorous training, extensive examination and maintenance of expertise. This training takes years, and maintaining expertise requires time, so a cost-cutting shortcut is to skip all that training and testing and to just take a weekend course. To figure this out, simply look up the surgeon you are considering on the American Society of Plastic Surgeons (ASPS) website. The American Board of Plastic Surgery has certified all members of ASPS, and they are all in good standing.

Where your surgery is performed is as important is who is performing the surgery. Confirm that your surgeon operates in an accredited operating room. Qualified accrediting/certifying agencies include AAAASF, AAAHC, IMQ, Medicare and the state your surgeon practices in. These agencies regularly check the facilities they accredit or certify for multiple safety features, including the physical facility, staffing, policies and procedures, emergency protocols and much more. Safety is expensive, so a great way for a surgeon to be able to offer a lower price is to cut corners on patient safety.

Local vs general anesthesia?

One way to cut corners is to operate in a facility that is not designed for general anesthesia. The cost-cutters play into patients’ fears by advertising “safe” local anesthesia to avoid the dangers of general anesthesia. All plastic surgeons have the capability to perform breast augmentation under either local anesthesia or general anesthesia. For most patients, the safest option is general anesthesia, which gives you a protected airway. Heavy sedation can slow your breathing down. It is difficult to put an implant under the muscle in an awake patient (you can’t numb the muscle), and pain results in high blood pressure, which can increase bleeding during the case.

If you choose a great plastic surgeon who prioritizes patient safety above all else, do you really think he or she would choose general anesthesia if local anesthesia were the safer choice?

What do other patients say?

Now that you’ve found a well-trained surgeon who doesn’t cut corners on safety, you still have more homework to do. How do you know if the surgeon is going to listen to your goals, if you’ll receive the care you deserve and how happy most patients are with their results? Although online reviews aren’t perfect, nonetheless it is nonetheless worthwhile to check them out. Keep in mind that negative reviews may be legitimate, but they might have been posted by a jealous competitor, a disgruntled former employee or a patient with problems that aren’t actually related to the surgery.

On the other hand, the surgeon’s own office staff might have posted a string of raving five-star reviews. Look for similar wording and sentence structure as a clue that one person posted multiple reviews.

If you find completely different review lengths and writing styles, the reviews are likely to be legitimate. In addition, if a surgeon has a score that’s high, but less than five, that is also a good sign that the reviews are legitimate. No one can truly please everyone.

What about the results?

Most plastic surgeons post before-and-after photos in a photo gallery on their website. When looking at the photos, look for consistency between the before photo and the after photo. The lighting, background, and camera distance from the patient should all be close to the same. Look for a frontal view and a side view. If you see only a three-quarters view on all photos, there may be a reason; it is easier to hide surgical differences in the left and the right when the patient is partially rotated away from the camera.

Another thing to look at is the natural mismatch in the breasts. No two breasts are the same. If there are differences in the left and right, is it because the patients’ breasts are different? Or is it because one implant was placed higher or lower than the other? If one breast is naturally larger than the other, did the surgeon improve that by using different sized implants?

If you choose a surgeon who isn’t expertly trained or doesn’t get great results, if you return for free or low-cost revision, do you think you’ll get the result you want? Probably not. If you go to an expert to revise your breast augmentation, the cost will likely be higher (sometimes significantly so) than the cost of an initial breast augmentation. It is usually much more difficult to fix a poorly done breast augmentation than it is to do the first augmentation right.

Contact the office

After you’ve winnowed down your selection to one or two plastic surgeons, you might want to fill out a contact form on the practice website; attentive, well-trained office staff should get back to you no later than the next business day. The office may offer a virtual consultation, in which you can submit photos securely. This can be helpful if you have extreme asymmetry, breast droop or other factors.

When calling the office, note how the staff answers the phone. You may be transferred to a patient coordinator (PC), who should be well-trained to answer questions, including a range of fees. Not all breast augmentations are straight forward. Depending on the shape and tone of your breasts, it’s possible that the surgeon may recommend a lift on one or both sides or some other additional procedure. The PC will try to give you an idea of the range of costs so that you are prepared. Financing options are also something you can discuss with the PC.

Local Anesthesia Breast Augmentation

Dr. Alfonso Barrera chooses to perform surgical procedures under a combination of IV sedation and local anesthesia because it is very comfortable for the patient. It is similar to taking a nap and comes with the following additional benefits:

One of the primary benefits of IV sedation is that we can achieve a desirable level of sleep state without having to intubate a patient. The avoidance of a breathing tube can improve the overall experience for the patient by preventing the sore throat that may occur after intubation.

IV sedation is extremely safe and effective. Adjustments to dosing and depth of this sedation enable us to ensure the desired level of relaxation throughout an entire procedure. The rate at which the body responds to adjustments also fosters safety related to the use of reversal agents, should we need to lighten the level of sedation at any time.

Will I Feel Any Pain While Under IV Sedation?

Patients do not feel any pain during their sedated procedure. Dr. Barrera combines IV sedation with a local anesthetic. He adds often a long-acting local anesthetic (EXPAREL) which will allow the patient to go home soon after the procedure and with minimal to NO pain at all.

How Will I Feel After Being Under IV Sedation?

Patients should expect to feel a little sleepy for several hours after treatment. We suggest that a loved-one drive our patients home and that someone remain with the patient for the remainder of the day. Assistance may be needed to get out of bed or use the bathroom during the first day.

Testimonials

“Thank you for all you have done for me this past year and for being so considerate and patient and being a friend as well as my doctor. It really makes a difference.”

“Thank you for taking great care of Andy. I have never known a doctor to be as caring and patient as you are (and I have worked with over 100 others) you can be sure we will spread the good news.”

Frequently Asked Questions

What Type Of Anesthesia Is Necessary For Eyelid Surgery?

I always do my eyelid surgeries under a twilight IV Sedation and Local anesthesia. There is No pain at all during surgery and little to no pain afterwards. It is extremely rare to have nausea or vomiting after surgery, which allows a faster recovery to go home or to a local hotel the same day soon after the procedure. This also eliminates the risk for Deep Vein Thrombosis and Pulmonary emboli which may occasionally occur when done under General Anesthesia with gases.

What Type Of Anesthesia Is Best For Rhinoplasty?

Generally, I do all my Rhinoplasties under a twilight IV Sedation and Local anesthesia, There is no pain at all during surgery and little to no pain afterward. It is extremely rare to have nausea or vomiting after surgery, which allows a faster recovery to go home or to a local hotel the same day soon after the procedure. Only if extensive septal or turbinate surgery is needed, would I use general anesthesia.

What Type Of Anesthesia Is Best For My Breast Augmentation?

All my breast augmentations are done under a twilight IV Sedation and Local anesthesia. There is No pain at all during surgery and little to no pain afterwards. It is extremely rare to have nausea or vomiting after surgery, which allows a faster recovery to go home or to a local hotel the same day soon after the procedure. This also eliminates the risk for Deep Vein Thrombosis and Pulmonary emboli which may occasionally occur when done under General Anesthesia with gases.

What Type Of Anesthesia Is Necessary For Gynecomastia Correction?

Dr. Barrera does all his gynecomastia correction surgeries under twilight IV Sedation and Local anesthesia, No pain at all during surgery and minimal pain afterwards. It is extremely rare to have nausea or vomiting after surgery, which allows a faster recovery to go home or to a local hotel the same day soon after the procedure. This also eliminates the risk for Deep Vein Thrombosis and Pulmonary emboli which may occasionally occur when done under General Anesthesia with gases.

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