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Breast Implant Procedures under Conscious Sedation: A 6-Year Experience in 461 Consecutive Patients

Gart, Michael S. M.D.; Ko, Jason H. M.D.; Heyer, Kamaldeep S. M.D.; Mustoe, Thomas A. M.D.

Plastic and Reconstructive Surgery: May 2013 - Volume 131 - Issue 5 - p 1169–1178
doi: 10.1097/PRS.0b013e31828e2196
Cosmetic: Special Topics

Background: Breast implant procedures are commonly performed using general anesthesia; however, patient apprehension, the potential for improved safety, lower costs, and faster recovery times have increased interest in the use of conscious sedation in plastic surgery. The authors examined the safety and efficacy of breast implant procedures performed under conscious sedation over a 6-year period using their standardized institutional protocol.

Methods: Between 2002 and 2008, 461 consecutive patients underwent breast implant procedures under conscious sedation using a protocol of preoperative intravenous diazepam along with intraoperative midazolam, fentanyl, and local anesthetic. All operative and follow-up data were recorded. Augmentation mammaplasty patients were further analyzed for conscious sedation medication dosing.

Results: The study population was divided into two groups (years 1 to 3 and years 4 to 6 of the study period) to analyze changes to the authors’ regimen over time. In years 4 to 6, higher preoperative doses of diazepam (p = 0.01) allowed more effective local anesthesia administration, thereby reducing intraoperative fentanyl requirements (p < 0.0001). Midazolam doses and operating times did not differ significantly between groups. No patient required conversion to a deeper method of anesthesia. The overall complication rate was 4.34 percent.

Conclusions: The authors’ study demonstrates the safety and efficacy of conscious sedation in breast implant procedures. Higher preoperative doses of diazepam have significantly reduced fentanyl requirements, resulting in shorter recovery times, decreased postoperative nausea/vomiting, and elimination of unintended admissions. These benefits are obtained without increasing operative times or complications. The authors conclude that conscious sedation is the preferred method of anesthesia for most patients undergoing breast implant procedures.

Chicago, Ill.; and Seattle, Wash.

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwestern Memorial Hospital, and the Department of Surgery, Division of Plastic Surgery, University of Washington.

Received for publication September 2, 2012; accepted November 2, 2012.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, 675 North St. Clair Street, Galter Suite 19-250, Chicago, Ill. 60611

©2013American Society of Plastic Surgeons