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Are you "Knocked out" OR just "Sedated" during surgery? What's the Difference?

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Hi Everyone,

A question for members and surgeons,
Do you know if during a gynecomastia surgery you are knocked out OR just in (deep?)sedation? What is the difference between the two?
Lastly, can this surgery be done with only local anesthesia!?
Has anyone done the surgery with local anesthesia only meaning not being deep sedated/asleep?
If for example just a small amount of breast tissue is removed behind the nipple, is it still a must to be in deep sedation?

Thanks and Regards,
Neil


Linkback: https://www.gynecomastia.org/smf/index.php?topic=24238.0

Anesthesia completely knocks you out, no question about it. My surgeon told me to count until 10, I don't remember counting after 4.
You wake up in a different room, usually with your compression vest already on you.

I personally cannot give you an answer about local, but I really don't see why people are scared (not saying you are) and try to avoid general. It's simply the best; it reduces pre-operative stress knowing you won't feel a thing and it's very safe with today's technology.
Of course what I'm saying is based on my experience.
And to answer your question, I'm no doctor but yes, gynecomastia procedures can be done with local anesthesia as far as I know - I guess it really just depends on the case and the patient's request.
Hope this helps! If you have any other questions, do not hesitate!

It all depends on the surgeon.
Some surgeons prefer to use general and some prefer twilight. I am not sure some surgeons prefer local anesthesia but I know it's been done under local too.
You have to discuss this with your surgeon and he will tell you what he prefers and if he can do it under local in your case.
My advice would still be to go with whatever type the surgeon usually uses.

Thank you guys!
sorry what is the diffrence between "general and .. twilight"?
It would be interesting to know what the surgeons here think about local anesthesia..
I guess with local anesthesia you see what they're doing so they better do a good job.
so.. maybe not such a good idea to ask them what they REALLY think. maybe there is just a little conflict of interest here:) Just joking!

But seriously, I'm very interested to know what they the experts think about local..

Regards,
Neil

Twilight is an IV sedation, it's not as strong as general but you won't see nor remember anything.
You can actually find more details about the different types of anesthesia and what the supporting doctors think in the following thread:
https://www.gynecomastia.org/smf/index.php?topic=23945.0

Even with local I am not sure you really see or want to see what the surgeon is doing.

Thank you very much for the link, great information!

Correct, I would not want to see what they are doing (was just joking about that) but would be more comfortable with local if the surgeon is ok with that too.

Regards

im having my surgery in 5 days
my surgeon is performing lipo + excision + maybe replacement of the nipples, no cutting sking) and he will use local anesthesia plus sedation
he told me he usually uses that method with most of the patients, apparently, with general anesthesia you can have some side effects (1 case out of 10.000) so he doesnt uses it unless its completly necesary, at least in gynecomastia surgeries
he told me i can feel something during the surgery, during lipo actually, not really during excision, but i will never feel pain, if im relaxed enough i should be sleeping during the process, they could easily wake me up, so i dont know what kind of sedation they will do, i trust my surgeon with that, he did it so many times like that, and no complains till now

its an interesting threat, share ur experiences guys

its an interesting threat
correct, it's an interesting threat.. but you meant thread:)
Thanks for sharing. what is the main difference medically. I mean if you are asleep you are asleep no? I guess different ingredients are used therefore risk is different. Good for you going with local/mild sedation

Most surgeons use either IV sedation (twilight sleep -- which is my preference) or general anesthesia.  From the patient's point of view, both are safe and you are asleep with both -- no pain, no awareness, etc.  The main difference is that general anesthesia renders you unconscious -- so that a breathing machine is necessary for you.  With twilight sleep, you are sleeping but breathing on your own.  The result is a quicker awakening from surgery with rarely any nausea or hangover.

I very rarely use local anesthesia alone.  First, you are awake and will feel the injections of the local anesthetic (not very pleasant).  And local anesthesia does not adequately deal with the pain from lipo, which is often necessary and  frequently done at the same time.  If indeed you have a very tiny amount of tissue just under the areola and otherwise are slender with a taut-skinned chest, then local anesthesia might work -- but these are indeed rare cases.

Dr Jacobs
Dr. Jacobs 
Certified: American Board of Plastic Surgery
Fellow: American College of Surgeons
Practice sub-specialty in Gynecomastia Surgery
815 Park Avenue
New York, New York 10021
Telephone:  (212) 570-6080
Email:  dr.j@elliotjacobsmd.com
Website:  http://www.gynecomastiasurgery.com
Website:  http://www.gynecomastianewyork.com/revi

its an interesting threat
correct, it's an interesting threat.. but you meant thread:)
Thanks for sharing. what is the main difference medically. I mean if you are asleep you are asleep no? I guess different ingredients are used therefore risk is different. Good for you going with local/mild sedation
oh yes, sorry, english is not my first language, sometimes i type really rare stuff hehe.

I think i will have the kind of sedation Dr Jacobs just mentioned, like sleeping and everything, easy to wake up, with no breathing machine, and local anesthesia.

Another thing, sometimes I feel so much stress before the surgery, even dizziness in my head, any tips to rellax about it?
can be a problem that for the sedation? maybe im too nervous about it.
I had my blood tests fine last week but lately im so much sensitive, its only 4 days now before my surgery.

Thanks.

"except when he accidentally went too deep which HURT"
VERY INTERESTING!
I wonder how often suregons go too deep, why this happens and what can it cause/damage??

I mean when we are sedated we dont even know it happens.
Regards

maybe one of surgeons can help us understand - regardsing sedation by twilight you refer to the same sedation done when scoping a patiend (endoscopy from mouth to look inside stomach)? OR for gyne different type of sedation is used?
THANKS.

just refreshing to see if any of the surgeons can please reply re: last 2 comments of mine.. Thanks

Quote
regardsing sedation by twilight you refer to the same sedation done when scoping a patiend (endoscopy from mouth to look inside stomach)? OR for gyne different type of sedation is used?

In general, the sedation for endoscopy is lighter than the sedation for gyne surgery.

Quote
I wonder how often suregons go too deep, why this happens and what can it cause/damage??

Possibly the surgeon went into the pec muscle -- which can hurt.  Usually it heals with no damage.

Dr Jacobs