Are you choosing the right anesthetic for your breast augmentation surgery?

Park Clinic Plastic Surgeons do not and will never perform twilight anaesthetic for breast augmentation surgery!

A lot of our patients have been asking about twilight anaesthetics, especially with reports in the media about multiple patients who have had problems associated with local anaesthetic overdoses and almost dying as a result of it. Whilst we cannot comment on cases we are not directly involved with, we thought it might be a good opportunity to explain twilight anaesthetics and why we only use general anaesthetics in our practice for breast augmentation surgery.

Firstly, a twilight anaesthetic is one where local anaesthesia is often mixed with other powerful medications through the veins that make you drowsy and give you amnesia (memory loss).

The main difference between a twilight anaesthetic and a general anaesthetic is that with a general anaesthetic, your expert anaesthetist can put in a breathing tube to make sure you can breathe freely and safely and will often use a special machine called a ventilator to make sure of it. We also use a powerful brain monitor to ensure that there is no sensation of pain whilst asleep. The amount of local anaesthetics used here are significantly less because you will be asleep for the whole procedure. We commonly use one of the latest techniques called TIVA which is called a total intra-venous anaesthetic which will enable you to wake up with less nausea than conventional anaesthetics.

Local anaesthetic overdose is an entirely preventable event caused when your doctor simply administers too much of it. It is not the patient’s fault, an allergy or an unlucky event. If it happens there is a very high mortality rate associated with it (meaning a good chance you would die). Some of the common features of local anaesthetic overdose are severe seizure activity right before cardiac arrest occurs as a result of a fatal heart rhythm.

So why would you want to have a twilight anaesthetic?

We believe that twilight anaesthetics are not really suited to breast augmentation surgery. Because the area needing to be anaesthetised is quite large and frequently below the chest muscle, it is easy to use too much anaesthetic and very difficult to really provide good pain relief unless you are fully asleep. The medication often given to you is called midazolam that gives you amnesia as well as sedating you. This might mean that you can be incredibly uncomfortable and in pain during the procedure but will not remember the experience afterwards. This is not the experience that we would want you to have, regardless of whether you can remember it or not. If you are going to have a breast augmentation under twilight we would suggest making sure the clinic you are having it in has the ability to change to a general anaesthetic during the operation if you are getting close to your maximum dose. If they can’t then you might want to consider going to one that can.

Is twilight easier on your body?

For some elderly patients who have a multitude of medical conditions such as recent heart attacks, a general anaesthetic might not be a good idea. Fortunately, with young healthy patients having breast augmentation, this is not an issue. The risk of you having a major problem with an anaesthetic is usually less than 1/200000. Our expert Anaesthetists will see you for a detailed assessment on the day of surgery and discuss the perfect anaesthetic for you. You may wish to contact them in the preceding days if you have any specific concerns.

Is it safer for you to have a twilight anaesthetic?

The answer to this is also no, especially given the recent events described in the media. At Park Clinic we use fully qualified anaesthetists in Sydney’s best hospitals to make sure you are safe and comfortable throughout your procedure. We perform all of our breast surgery in fully accredited hospitals not in the back of our clinic for this reason.

Is it easier to perform the procedure under twilight?

No. Contrary to popular opinion, a breast augmentation is a complicated procedure and everyone is different. There are many reasons why the vast majority of plastic surgeons in Australia don’t do twilight for breast augmentation. The size and shape of your implant as well as technique of the procedure varies greatly between individuals. If you are drowsy, moving around and excessively swollen with local anaesthesia it means it can be more difficult to see subtle differences in shape and position that are important with your final result.

Is twilight less painful?

No. For a general anaesthetic you are completely asleep the whole time and have just the right amount of long lasting anaesthetic placed in to keep you as comfortable as possible for the first 6-8 hours afterwards. For a twilight, you will have a large number of injections with needles approximately 10cm long into your chest and breast. Most patients will have some distress but usually have no memory of it afterwards. It is reasonable to expect similar post-operative pain with either technique which is usually treated with tablets alone.

Is twilight cheaper?

Yes. No doubt. Twilight anaesthetic is definitely cheaper for the clinic to provide this kind of service to you. Why? Because you may not have an anaesthetist, you don’t have to go to a proper hospital, you don’t need anaesthetic nursing staff. A proper hospital has to comply with rigorous standards with state of the art machinery such as ventilator machines. Clinics that only offer twilight alone do not have to do this. Hopefully the clinics that use this kind of technique can pass on those savings to the patients by offering a cheaper option. We believe that you wouldn’t want to compromise your safety for price alone. This applies to buying a car or having surgery alike. You only have one life. Proper hospital facilities, fully qualified anaesthetists and general anaesthetics cost money and these costs are passed onto the patient for your peace of mind.


You can make up your own mind here. It is our firm belief that the best, and safest, experience we can provide is with a general anaesthetic and not a twilight for the reasons described above. Patient safety is one of the fundamental features of your experience at the Park Clinic. We hope we’ve helped with this post. If you’d like to discuss things in more detail or find out how this might apply to you please contact our team on 1300669488 for more information.

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Suite 4/ Level 6 75 Crown St
Woolloomooloo NSW 2011

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