For patients undergoing breast augmentation mammoplasty 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 mammoplasty, breast lift mastopexy, breast reduction mammoplasty, 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.

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 sight or die due to the effects of general anaesthetic – but the risk is extremely low at 1 in 100,000.

Overall, general anaesthetic should always be 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 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 less daunting approach for patients, twilight sedation is a far riskier option. Plastic surgeons do not recommend twilight sedation for surgical breast procedures.

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 mammoplasty?

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 mammoplasty be with twilight sedation?

While some minor procedures such as lesions, some X-Ray procedures, dental procedures. and medical examinations can be performed under twilight sedation, invasive surgeries such as breast augmentation mammoplasty 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. 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.

If you have any questions about the information contained in this blog post, don’t hesitate to contact Dr. Richardson’s rooms here.