Options for Anesthesia in Gynecomastia Surgery
Local, IV Sedation, and General Anesthesia
Local Anesthesia This form of anesthesia consists of the infiltration of lidocaine, marcaine, epinephrine, and bicarbonate (tumescent). Lidocaine is a short-term local anesthetic agent and lasts between 30 minutes and one hour. It provides complete numbness of the area so as to cause a loss of feeling temporarily in a limited area. Marcaine has the same function as Lidocaine but with longer-lasting results, causing numbness for up to a few hours. Epinephrine constricts the local blood vessels and therefore reduces the bleeding and makes excision and Liposuction easier and more efficient. Bicarbonate reduces or eliminates the burning sensation while getting local anesthesia. A certain combination of all these local anesthetics is called tumescent anesthesia.
All those ingredients are injected slowly to the chest tissue, initially through a very small gauge needle (usually #30 gauge) so as to cause the minimum burning sensation and discomfort. Subsequently, additional local anesthesia is infiltrated through those areas that have been previously anesthetized.
IV (Intravenous) Sedation IV Sedation (also known as local stand-by) is an excellent method of anesthesia that puts the patient to sleep. IV sedation requires the presence of a board-certified anesthesiologist that is experienced in this kind of sedation. There is no need for intubation (insertion of a tube down the throat). IV Sedation is a safe form of anesthesia, the after-effects are minimal and the patient usually wakes up fairly quickly.
General Anesthesia General anesthesia is not used in our office. It is more aggressive and the patient is always intubated (has a tube inserted in the throat) and as a result may suffer some throat soreness later.
Determining Choice of Anesthesia Every patient has different needs and accordingly has to choose a form of anesthesia best suited to him in consultation with his plastic surgeon.
Local anesthesia is tolerable to many patients but not to all. There is the psychological fear of remaining awake and aware during surgery. Other patients prefer local anesthesia because it is safe and effective and requires less recovery time. Another consideration is cost. Local anesthesia is less costly than IV sedation.
The size of the breast glandular tissue is a very important factor in selecting the type of anesthesia. IV sedation is usually the preferred method for larger and more complex cases of gynecomastia and cases that include extensive liposuction. In smaller cases (including puffy nipples) local anesthesia should be strongly considered. However, ultimately the tolerance and psychology of the patient will be the most important factors in choosing a method of anesthesiology.
Every plastic surgeon should discuss the various methods of anesthesia at great length with the patient. Together, the plastic surgeon and the patient will determine the type of anesthesia considering the patient’s tolerance, needs, and in some cases also financial resources.