Treasure Chest

Glendale surgeon talks patients through
breast implant surgery.

Expert Witness

by Kate Nolan

Dr. Kulbhusan Sharma may have the best bedside manner of anyone, at least for breast augmentation patients. Sharma lets patients talk to him during surgery. He’s one of the few doctors in Arizona who does breast augmentation using a local anesthetic, allowing patients to remain conscious throughout. Sharma, who does the procedure at Arizona Vein and Laser Institute/Cosmetic Surgery and Med Spa in Glendale, says being awake during this surgery has certain other advantages, too. We asked him to give us the details.

Since you don’t use a general anesthetic for breast augmentation, how do you control pain during the surgery?

We don’t use any kind of sedatives or regional anesthetic. Instead, we prepare a special solution of the local anesthetic called lidocaine. It lasts three to four hours, while the procedure itself only lasts up to two hours. We can give more if needed. Some are more sensitive, and we can respond to that because the patient can tell us. Once we give the local anesthetic, the patient is very comfortable.

What’s the advantage of using a local anesthetic over a general anesthetic?

You can monitor the patient very well, and don’t require an anesthesiologist. Any discomfort, you know right away. Recovery is very fast. We monitor the patient afterward—if the vital signs are fine, they walk out. Being under a local allows you to talk. The biggest advantage is that before the implant is final, we let the patient see the size. She can decide whether she wants a smaller or larger implant. Patients are happy they have input during the procedure. Most patients do change their size, mostly up, during procedure. Very few go down.

What’s it like for the “awake” patient?

The patient is numb and can’t feel or see what I am doing. But she is talking with me, the nurse and her husband or partner. We monitor her and also can see from the monitor whether there is discomfort or not. A few women request a sedative, and we’ll give a light sedative, but not generally. Typically we talk throughout the procedure. Talk is good—it tells me my patient is comfortable and her vital signs are good.

How is the procedure done?

The anesthesia takes about 15 or 20 minutes to work. Then we make an incision and insert the saline implant. We always place it under the muscle, the best placement for a natural look. And also it doesn’t interfere with breast tissue or mammograms. If it is above the muscle, there is a lot of bounce. After the procedure, the patient briefly takes pain medication because the muscle becomes sore from stretching.

Are there any risks or side effects to watch out for?

The risks are the same as for any procedure—infection or bleeding. But there are no specific risks with local anesthesia. We always check first for an allergic reaction.

Who is a candidate for the “awake” procedure?

Any woman would qualify for breast augmentation with a local anesthetic if she is not 
allergic to the anesthetic. The allergy is rare.

For more information on Dr. Sharma and details on breast augmentation, call 602-298-5476 or 602-547-2690.