Абстракт

Objectives: The primary objective of this presentation is to introduce a novel protocol for implant-based breast augmentation performed entirely under intravenous (IV) sedation without endotracheal intubation. We aim to evaluate the clinical efficacy, safety, and operational advantages of utilizing a submuscular tumescent injection technique. By shifting away from general anesthesia, this study seeks to demonstrate a less burdensome, efficient, and accessible surgical alternative for both patients and outpatient cosmetic clinics. Introduction: Traditionally, implant-based breast augmentation is performed under general anesthesia. However, this places a significant physiological burden on patients and requires extensive facility setups, which may be unfeasible for certain clinics. Intravenous sedation offers a promising alternative but requires profound local analgesia. We hypothesize that integrating IV sedation with targeted submuscular tumescent infiltration can provide adequate anesthesia and hemostasis, eliminating the need for intubation while ensuring optimal patient comfort. Materials / method: A clinical review of primary breast augmentations was conducted. Patients received IV sedation using a carefully titrated combination of propofol, midazolam, and ketamine, strictly without intubation. Following a minimal incision of under 3.0 cm, a specialized tumescent solution was injected directly into the submuscular space. This localized infiltration was strategically utilized to induce widespread regional anesthesia, achieve hydrodissection, and facilitate optimal intraoperative hemostasis prior to the surgical dissection and implant insertion. Results: The procedure was completed rapidly and safely across all cases without requiring conversion to general anesthesia. The submuscular tumescent technique provided excellent pain control and drastically minimized intraoperative bleeding, ensuring a clear surgical field. Consequently, implants were successfully placed through minimal incisions (< 3 cm) with precision. Patients experienced a smoother postoperative recovery, absence of intubation-related discomfort, reduced nausea, and a significantly faster discharge time compared to general anesthesia. Conclusion: In conclusion, implant-based breast augmentation can be performed safely and efficiently under IV sedation without the need for general intubation. The pivotal element of this approach is the precise application of submuscular tumescent injection, which guarantees simultaneous local anesthesia and robust hemostasis. This minimally invasive protocol significantly reduces the physiological burden on the patient, optimizes operative time, and offers a highly reliable, practical solution for ambulatory plastic surgery centers.