An April 8th, 2010, New York Times contained an article discussing a relatively new technique for augmenting breasts called Awake Breast Aug. Their article, entitled Awake for Breast Implants? If You Wish. The link for the article can be found by clicking here.

I feel very honored that this international magazine picked me for this interview. For the prior two weeks, their chief editor and I had discussed the multiple merits of this procedure. They wanted to know multiple things, including how I can perform this procedure so that the patient is comfortable and pain free during the augmentation if done while she’s awake. I answered that I use mild sedation coupled with a special local anesthetic called tumescent fluid. It numbs the breasts so well that the procedure can be performed while the patient is awake.

They also interviewed a few of my patients, one of which they quoted. Jane Z., my patient, discussed how she was thrilled that she could choose her implants size during surgery. The reason is because she was awake during the procedure. Jane had seen many other cosmetic surgeons but was unhappy with their results. After I redid her breast augmentation using this Awake Technique, she was ecstatic and is extremely happy with her results, as she discussed in the article.

Here’s an excerpt from the article:

SOON after Jane Z. had her B-cup breasts augmented for the first time, she realized she hadn’t gone big enough. So the second time, Jane Z., who preferred to not have her last name mentioned, was thrilled that she could choose her implant size during surgery. How? She was awake. Most women who get breast implants do so under general anesthesia. But Jane Z.’s doctor was Dr. Robert L. True of Colleyville, Tex., one of more than 100 doctors nationwide who advocate local anesthesia and sedation for aesthetic surgeries like breast augmentations.

They are talking to me the entire time, Dr. True, an obstetrician and gynecologist by training, said of the (over) 75 patients whose breasts he has enlarged in his accredited facility. Once the new implants are in, his patients are propped up on the operating table, look in a mirror and have their say. They like that little bit of autonomy, he said.

Awake Breast Aug is getting more and more popular.

Physicians across the U.S. perform Awake Breast Augmentation, which allows us cosmetic surgeons to enhance a woman’s breasts comfortably while she is awake using only mild sedation and local anesthesia. Thus, potential complications of general anesthesia are avoided, and the patient is given more choice for her final result; plus the results are fabulous.

Breast Augmentation is the most common cosmetic surgery performed on women in the United States. With this Awake technique, it is a safer surgery and gives patients more choice. Many women do not want to be put to sleep for a cosmetic procedure. This allows the cosmetic surgeon to do augment her breasts without the patient going asleep with a general anesthetic.

Avoiding a general anesthetic is a big thing amongst women. During the Awake procedure, the patient is comfortably awake and is able to converse with me, even though they had been given mild sedation. Using the special anesthetic fluid also decreases other potential medical problems that may accompany breast augmentation. There is less infection and minimal, if any bleeding.

Although there are other physicians who do not agree with performing breast augmentation while the patient is awake, none can dispute the fact that it is indeed a safer procedure with less potential complications than when performed while the patient is asleep with general anesthesia. However, the news must present both views, so I would like to address some of the other comments made in this New York Times article by the other professions.

The article quoted an anesthesiologist who said that using tumescent anesthesia must avoid an overdose, which can lead to seizures and abnormal heartbeats. This is in reference to using very high doses of lidocaine. If we give too much lidocaine, of course potential problems could occur.

The reality is that if you do the procedure correctly, you will never experience these problems because you simply don’t give the patient excessive lidocaine. In fact, I am very careful with the dose of lidocaine and calculate the maximum dose; so these fears are unfounded and just don’t happen.

There have been very few cases reported of this lidocaine overdose problem while doing a cosmetic procedure and almost all had to do with incorrect technique and dosing. I teach the tumescent technique to other physicians from around the country and emphasis the need for safe dosing of lidocaine. None of my students have had this problem, nor will they as long as they do the procedure correctly. I tell my students, As long as you do the tumescent infusion as I teach it, you won’t get in trouble.

Another anesthesiologist discussed the possibility of aspiration with mild sedation, which is also a very rare potential complication. We don’t do deep sedation, nor do we do general anesthesia. Using those types of anesthetics have a much higher chance of aspiration problems versus when the patient is awake. The risk of aspiration with mild sedation is exceedingly rare since the patient is awake and she can cough normally. She can’t with the other two types of anesthetics which we don’t use. Thus, the awake technique should be preferred if they were worried about aspiration problems.

One of the plastic surgeons commented about many physicians who perform breast augmentation after just doing a two day course. He said that it took us six years to fully train plastic surgeons to do breast augmentation. This is actually a very misleading statement. Plastic surgeons train to do reconstructive surgeries for the six years they are in residency. This includes all parts of the body, not just the breasts as this statement would imply. Most get little actual cosmetic breast surgery training during residency unless they do special courses on cosmetic surgery similar to other surgeons.

Because I teach for the AAOCG, I always recommend that physicians take more than one course on breast augmentation before they start doing the procedure. They should also do some hands on training with other physicians who do the procedure. There are many excellent teaching academies that offer breast augmentation teaching for surgeons. Whether they were originally trained in reconstructive surgery or other surgical fields, they all should receive continual training as I do. The surgical techniques are very similar, as are the outcomes, regardless of the original surgical training. The real key to the final outcome is the talent and artistic skills of the surgeon, combined with adequate training and knowledge.

An interesting question from the editor was about the cost of the procedure. We charge less than most other physicians because the patient does not have to pay extra for facility fees of an outpatient center nor extra anesthesiology fees. She asked if that was the main reason why patients came to see me. Although this is a great reason, in actuality, the main reason is that they want to avoid a general anesthetic. People are not coming to me because it’s cheaper. They don’t want to be put to sleep.

One other interesting comment was about choosing the size for her breasts intraoperatively while the patient is mildly sedated. We have had no problem with this, and most patients like the fact that they have a choice in the ultimate size of their implants. This is explained before the procedure and the patient always has the option to have a significant other come into the room to help them make this decision if they choose. Most patients are happy that they are given this opportunity of choice, which is a great thing.

These procedures should always be performed in an accredited facility. When performed in an accredited facility, the surgeon has taken the extra effort to make sure that the safest environment is made for the patient. Many offices are not accredited and should strive to receive this accreditation for their patient’s health concerns.

My facility, the True Aesthetics Center, is accredited by AAAHC (Association of Ambulatory Accreditation of Health Centers). I continually exert great efforts to ensure that proper safeguards are maintained and adhered to in my facility. These not only make it better and safer for the patient while performing the procedure, but the outcomes are better too. Maximizing results are what we strive to enhance a patient’s natural beauty.

For more information on Awake Breast Augmentation and to see before and after photos, click on the Photos tab from my website at or see my other site at If you would like to make an appointment for a consultation, call my office at 817-399-8783.

It is with much sorrow we must share with you our wonderful physician, Dr. Robert True, passed away. Because his death was not anticipated, we are in the process of finding a physician to care for our patients and have a temporary physician and nurse practitioner in place. If you are in urgent need of your medical records, please contact us at 817-399-8783 so we may send you the legal medical records request form. We appreciate your patience as we work through this situation to try and maintain our practice.