Each surgeon by virtue of his/her training, experience and surgical judgment is responsible, and must a determination for his or her approach to a given medical situation.
In applying this fact to selection of type of anesthesia, if your surgeon recommends a specific type of anesthesia, then the patient must accept that recommendation.
Of course, a second opinions is always an alternative.
However, it is vital for a patient to check the credentials of the surgeon, including the surgeon’s hospital privilege list (those procedure that he is approved to do in that hospital).
This is important since there are many “cosmetic surgeons” that don’t have hospital privileges and must procedures in a non-accredited office under less than satisfactory anesthesia.
Many surgeons have accredited office ORs and hospital privileges to do those same procedures. (this is a requirement of AAAASF, the major office accreditation organization.) Accreditation is one other important credential for a patient to verify. Office surgery and /or local/IV sedation aren’t appropriate for all patients, as general health, patient concern, etc must be considered.Now for your specific question.
Tummy tuck under local anesthesia (including tumescent) and conscious sedation is perfectly safe and acceptable. Our practice has published nearly 600 cases of TT, and 1/3 of which were done under IV sedation and local anesthesia. Of these200 cases, approx. 1/2 were done in our accredited office surgical facility.
We had no complications related to anesthesia , minimal nausea and vomiting and most patient (in the Office) were discharged home within 30 min after surgery. (Aesthetic surgery J, August 12.) Post op pain management was not an issue in our series of 600. So what is the correct answer: It is between you and your surgeon! (Harlan Pollock, MD, Dallas Plastic Surgeon)
When considering IV sedatoin for a tummy tuck
Make sure your surgeon has considerable experience with this. I personally would never consider it but there are surgeons out there who can do this safely and comfortably for you. Most surgeons have their patients put to sleep for this and I can’t think of any good reason to have tummy tuck under tumescent. (Curtis Wong, MD, Redding Plastic Surgeon)
I agree that for most routine cosmetic abdominoplasty procedures the use of a certified operating room and general anesthesia is certainly the standard procedure. Most anesthesiologists I have spoken with agree with this. Other sedation techniques requested by patients may actually increase the risk of anesthesia. As a board certified plastic surgeon I am held to higher standard then many other cosmetic surgeons. This of course is a great thing because my goal is for maximum patient safety. (Gregory Lynam, MD, Richmond Plastic Surgeon)
I’ve never done that and I think most Surgeon Members of the ASPS and ASAPS would state that it is very difficult to tighten the muscles of your abdomen with that anesthesia technique. Abdominoplasty is the closest operation that I perform that makes me utilize all My General Surgery training with the intraop decisions and post op care. (Phillip Nunnery, MD, Panama City Plastic Surgeon)
Some surgeons recommend anesthesia based on the facility they have available. Personally, while I have dome many liposuction procedures under tumescent I would never recommend an an abdominoplasty be done that way.Abdominoplasty means different things to different people. What is needed ranges from a small skin resection to a major abdominal wall reconstruction. As I have gained experience I have found that in order to get consistently good results with abdominoplasty many factors need to be taken into account. It is a more complex operation than some would appreciate. Abdominoplasty is a big operation. There are risks of serious complications. Often a poor result is very difficult to revise. Know what you want, discuss the procedure with your surgeon and don’t skimp on the facility or anesthesia to make a price point. (Thomas R. Walek, MD, Providence Plastic Surgeon)
Tumescent tummy tuck?
Although a lot of things “can be done” doesn’t mean they “should be done”. This is a case in point.The other surgeons both said do not proceed and I wholeheartedly agree. Let me tell you why:
1. There is no medical reason that I can think of as to why local with sedation is better here than either general anesthesia or an epidural. With sedation, you will get more sedation and narcotic pain medicine which lasts in the body longer than if you are given an inhalational anesthetic (general anesthesia) which is eliminated fairly quickly from your body. Also, if your surgeon is having difficulty making your abdomen numb, there are limits to how much numbing medicine you can receive before the blood levels become toxic. If you require a lot of sedation, the amount you receive will be limited by the fact that your breathing and ability to protect your airway will be impaired if you receive too much sedation and then the anesthesiologist (your surgeon isn’t foolish enough to give the sedation himself, is he/she?) will have to put you to sleep anyway!
2. I agree, tumescent anesthesia is not the best way to proceed if you are plicating (tightening) the abdominal muscles, either.
3. This is a big operation and although some do it without general anesthesia, I feel that in my opinion this is a suboptimal way to proceed. It is harder on the surgeon not to have you asleep or with an epidural, and the only reason I can think of that some surgeons do it is to save money so as not to pay an anesthesiologist. An anesthesiologist will monitor your state of hydration and make sure you have receive enough intravenous fluid so that your blood pressure doesn’t go dangerously too low (or too high!). Safety matters above all else and I do not believe that this is a safe way way to proceed. Without the services of an anesthesiologist or at the minimum, a nurse anesthetist, I would consider this to be quite dangerous! (Mark D. Epstein, MD, Stony Brook Plastic Surgeon)
I would not recommend tumescent tummy tuck
I would not recommend only tumescent and iv sedation if you are going to have muscle plication. Perhaps with an epidural, would be a better alternative. I would also make sure your surgeon is truly a board certified plastic surgeon with privileges to perform abdominalplasty in a hospital. (Reps B. Sundin, MD, Richmond Plastic Surgeon)