1. Is it best to
have my surgery performed in an Out-patient Surgery Center or in a
hospital?
2. How long will it
take to perform my breast augmentation surgery?
3. How many types of
anesthesia choices do I have? Which is best?
4. What if I wake up
during my surgery but I cannot talk? Will I feel pain?
5. Can I be awake
for my breast augmentation surgery?
6. I am afraid of
needles, will it hurt very much?
7. I am afraid of
undergoing anesthesia, what should I expect?
8. I am embarrassed
of what I might say or do while anesthetized. Will I do anything
embarrassing?
9. Can my friend or
significant other watch my surgery?
10. Can I have a
video of my surgery?
11. When I wake up
from anesthesia, what will it feel like?
12. How long must I
wait before I am released to go home?
13. Should I stay
in a recovery center overnight instead?
1. Is it best to have my surgery
performed in an Out-patient Surgery Center or in a hospital?
Today's accredited ambulatory surgery centers (ASC) are
essentially mini hospitals. The benefits of having your surgery
in an out-patient facility are reduced cost to you the patient, a
surgical team which regularly works together (which is very
important), familiarity of the team with their surroundings (also
important), less time in the pre-operative room and actual
operating room, and less chance of infection.
The benefit of having a surgical procedure performed in a hospital
is only if you have an unrelated or possibly related medical emergency
during or after your surgery which requires the expertise of another
surgeon-type (for instance a cardiovascular surgeon in the event of a
heart condition). However, out-patient surgery centers are
well-equipped to handle most emergencies and an ambulance will get you
to a hospital promptly in the event that you need another surgeon.
This is not meant to scare you as the chances of your having a
major medical emergency that your surgeon cannot at least handle until
you are transported elsewhere is very, very rare. Your surgeon
had to undergo many years of medical training, including ER training,
to obtain his medical license. Plus, the surgery center must
have all of the essential items and training necessary to handle a
major medical emergency in order to be accredited. Just make
sure the facility is accredited.
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2. How long will it take to perform my
breast augmentation surgery?
It can take anywhere from an hour to three hours of actual
operating room time. Operating room time may increase with
additional procedures, or if there are specialized procedures to
perform such as capsule removal, free silicone removal, removal and
re-implantation, reconstruction, breast lift, etc. You must also
factor in the pre-operative preparation time which may take an hour,
as well as the recovery room time, which may take, on average, two
hours.
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3. How many types of anesthesia choices
do I have? Which is best?
There are usually two common types of anesthesia methods used in
breast augmentation surgery, Twilight (or conscious sedation) and
General anesthesia. Although both are safe, the method chosen is
usually dependent upon the type of procedure you have, for instance,
if you are having sub-pectoral placement, your surgeon may choose
General Anesthesia, and it also depends upon the method your surgeon
prefers.
If you are having additional procedures, your surgeon may choose
General Anesthesia as well. Some surgeons choose Conscious
Sedation (you are not really conscious, just sleeping very deeply but
able to breath on your own), if you are having a straight forward
breast augmentation. Please note, General Anesthesia is not
required for sub-pectoral placement.
Please see our Anesthesia section for
more information.
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4. What if I wake up during my surgery
but I cannot talk? Will I feel pain?
Your anesthesiologist monitors your level of consciousness and
necessary body functions very, very closely. Your level of
consciousness is determined by your breathing, heart rate, blood
pressure, and muscle control. Your temperature is also monitored
very closely. Your anesthesiologist constantly evaluates your
body's responses and adjusts medications accordingly.
You will not feel any pain during your procedure, but may begin to
feel slight discomfort or confusion upon awakening.
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5. Can I be awake for my breast
augmentation surgery?
Define awake. There are many levels of consciousness and your
anesthesiologist and surgeon prefer you to be asleep. This is
because if you are sedated you are less likely to move, talk, or
remember any of the trauma (sounds, smells, or anxiety) of having an
operation. This is actually better for you mentally than it
would be if you were awake for the entire procedure, experiencing
everything but the pain due to local anesthetics.
The exceptions may be patients who need very slight, in-office
incision revisions or fluid draining, or volume adding procedures.
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6. I am afraid of needles, will it hurt
very much?
Let your anesthesiologist know if you are very sensitive to needles
or have anxiety. She or he may give you an oral sedative
beforehand so that you experience less anxiety associated with
pre-operative preparation period. Also, some anesthesiologists
may choose to use a small needle to inject a local anesthetic in the
skin where your IV catheter will be placed. This will lessen the
pain associate with IV insertion. Although now you are receiving
two injections instead of one. But the choice may be up to
you.
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7. I am afraid of undergoing anesthesia,
what should I expect?
Usually all you will experience is the pre-operative excitement or
slight anxiety, which can be lessened with the use of an oral sedative
beforehand. The administration of anesthesia is usually played
out in three separate parts, you'll only slightly remember one, the
induction period (to put you to sleep). You will not be aware of
the second anesthetic period (or middle phase) that keeps you asleep
and relieves pain. You will also not be aware of the initial
recovery phase in which your anesthesiologist takes steps to awaken
you. During the entire period you are monitored extremely
closely for any changes in your body's functions and level of
consciousness.
This is generally how it will work: Your anesthesiologist will
normally use a intravenous induction agent such as Propofol or sodium
thiopental. This medication will put you to sleep although it is
temporary so your anesthesiologist will need to administer additional
medications to keep you asleep. Once you are stable and ready
for surgery, your anesthesiologist will monitor your level of
consciousness and administer medications as she or he deems necessary
throughout the entire procedure. Once your surgery is
complete, your anesthesiologist will slowly bring you out of your
state of unconsciousness by no longer administering some medications,
and by administering others to reverse other the prior medication's
effects. Your anesthesiologist may also administer
anti-nausea medications and antibiotics into your IV as well.
You, however, will only experience the sudden sleepiness and
sometimes dizziness as you fall asleep and then maybe memories when
waking up after your surgery is over.
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8. I am embarrassed of what I might say
or do while anesthetized. Will I do anything embarrassing?
First, don't be embarrassed, the surgical team has seen and heard
it all. With General Anesthesia you will normally do
absolutely nothing but lie there, oblivious to your surgery.
With Conscious Sedation, you may babble or talk softly at first,
occasionally making jokes, but it is usually unintelligible.
Let's skip to the really embarrassing functions that you are really
worrying about. I wasn't going to write about this, but
you'd be surprised at how many people actually share these concerns.
- Urination. If you are concerned about urinating on
yourself, don't. You haven't drank anything for probably
twelve hours, you were made to go to the restroom right before your
surgery, you aren't going to suddenly lose the ability to hold your
urine for the next two to three hours. You still retain
control over your natural functions. Plus if you are having
General you are usually catheterized in the event that you do not
have control over your functions.
- Flatulence. You know this is the reason you are
concerned. Okay, it has occasionally happens. But the
operating room is not exactly quiet. And in the remotest
possibility that you even do this, everyone in that room has passed
gas before. Everyone. Besides, anything you do in your
sleep is covered under the free pass rule. No pun intended.
If you feel especially self-conscious about it, don't eat anything
that causes you to be particularly gassy a few days beforehand.
- Inappropriate Behavior. The odds of you doing anything
less than respectable are astronomical. If it makes you feel
any better, I have only heard of it occurring with male patients
touching themselves and that has only been one instance I have heard
of. Male patients also are more likely to react when
they are coming out of anesthesia in aggressive and defensive ways.
It is almost unheard of in women. Also, you usually have your
arms strapped down. Again, don't worry.
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9. Can my friend or significant other
watch my surgery?
Some surgeons do allow this, however many are increasingly
disallowing it. I have seen male significant others pass out,
camera men pass out, and others get nauseated. It is best to let
your surgeon do his job and not have to worry about your husband
boyfriend, or friend. If your surgeon allows it, consider
yourself lucky. Although I have had my S.O. present in the
operating room many, many times, it has been disallowed once--by the
same surgeon after a patient's husband passed out during her surgery
the day before mine.
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10. Can I have a video of my surgery?
Some surgeons do offer video footage of your surgery, whether you
have your SO take it or his staff coordinates it, although honestly
this is very rare. Especially if the procedure is being
performed in a hospital. The exception is usually when a
documentary or news piece is being produced. Insurance usually
does not allow for footage of the procedure to be used for
un-restricted, general use
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11. When I wake up from anesthesia, what
will it feel like?
You will normally just feel confused and groggy. You may feel
a little discomfort or nausea. Be sure to let the surgical staff
or recovery nurse know how you feel as there are several medications
for any negative sensations you may experience.
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12. How long must I wait before I am
released to go home?
For the average breast augmentation-only procedure and under normal
recovery circumstances, you will have to stay about two hours, usually
no longer than three. The recovery staff just wants
to be sure you have no allergic reactions to any of the anesthetics or
other medications, develop no breathing or cardiovascular problems or
any apparent hematomas directly after your surgery. While you
are still at risk for a complication, anything life threatening is
more likely to occur within the few hours after surgery.
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13. Should I stay in a recovery center
overnight instead?
For a straight-forward breast augmentation procedure, in a patient
with no pre-existing disorders or high-risk conditions, it is usually
not necessary. If you choose to get extensive liposuction or a
tummy tuck procedure as well, you may be required to stay overnight.
I have stayed in an overnight facility for two days and although it is
an added expense, it is hugely convenient and safe. You are
served food, given medications, and all of your vitals are monitored.
Your safety is what is most important and if your doctor feels should
should stay overnight, consider it.
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