AWAKE Breast Augmentation & Other Fantasies

Cosmetic surgery fantasies.  Example:  the “lunch time miracle procedure with no downtime that does not require any anesthesia and makes you look ten years younger, immediately”.  Patients who believe this type of statement are going to be very disappointed.  Prospective patients routinely call our office to ask if our physicians perform various procedures they’ve seen advertised on the internet or heard about in a chat room.  Recently, a patient called us about AWAKE breast augmentation.  She had read about the procedure in a New York Times article.  After reading the article myself, I felt compelled to try to provide some education to my patients about the frenzy of marketing that surrounds the repackaging of cosmetic surgery.

“REPACKAGING” means the creation of another name for a cosmetic surgery that is already being done so that it can be remarketed as a fresh idea --- a cutting edge procedure.  For example, the New York Times article discusses performing breast augmentation under local anesthesia alone so that the patient can help select the implant that they like best during surgery. The practitioners of this technique indicate that it gives the patient greater autonomy (a bigger voice in the procedure) and is safer than general anesthesia. 

As a plastic surgeon who has performed hundreds of breast augmentations under sedation, I find this repackaging of a safe, reliable technique simply irresponsible.  The type of sedation used in our practice allows the patient to breathe on their own while they rest comfortably during their controlled, safe  procedure. Decisions regarding breast size should be made prior to surgery by way of a thoughtful consultation with the patient.  Handing patients implants and asking them to select the size they feel is appropriate is akin to your plumber asking you to select the equipment you think he needs for your job. As it turns out, the practitioners of this AWAKE technique are not Board Certified Plastic Surgeons, but have come to cosmetic surgery by way of Ob-Gyn, or even family medicine.  One such “Cosmetic Surgeon” offers a two day $7,000 course in his breast augmentation technique.  Two days—wow.  The plastic surgery residents currently studying with us will spend about 8 years in training.

The truth is that these operations may or may not be cheaper but definitely not  safer without an anesthetist or anesthesiologist present.  Cut rate fees attract patients to this group of practitioners whose greatest talent may be salesmanship. To paraphrase one of the doctors who performs AWAKE breast augmentation, “It is more safe,… Patients can scream and, you know,… I can’t be putting my needle there”.  You should know that local anesthesia cases can be performed in a doctor’s office and, thus,  avoid oversight of his safety practices by surgical accrediting agencies and major hospitals.  In many cases, the physician performing the case in his office does not have the credentials to perform the case in a major hospital that must answer to the State for the privileges they grant their surgeons.  If your surgeon does not have hospital privileges to perform the procedure you desire, you need to look for another doctor.  Additionally, most of these AWAKE technique surgeons give their patients oral sedatives prior to surgery.  No physician should rely on a sedated patient to make appropriate,  reliable decisions about implant size or anything else.

Repackaging is not limited to breast surgery.  Facial volume injection techniques have taken on a media  life of their own.  “Vampire” facelifts, liquid facelifts, and Stem Cell facelifts are just a few marketing terms.  Remember that there is no Stem Cell facelift anything that has been scientifically proven and accepted.  Most of these interventions are fat injections or some sort of blood plasma injection.  SCULPTRA injections have been referred to as a liquid facelift, but SCULPTRA -although it works well- only provides volume.

Be mindful of the minefield of cosmetic surgery repackaging and over-marketing. Educate yourself.  Visit Academic websites and not chat rooms where the conversation can be dominated by less than reputable people.   Look for Cosmetic surgeons who are certified by the American Board of Plastic Surgery. Your Cosmetic Surgery should be a positive memorable experience.