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Plastic Surgery/tummy tuck w iv sedation no general anesthesia


Hi. I have Myasthenia Gravis.  I was scheduled for fleur de lis on Nov 20, 2014.  Shortly after surgery started my bp and pulse dropped to a dangerous level and compresssions were started and surgery aborted. I was taken to ICU and had ct chest, leg Doppler and heart ultrasound.  All negative for dvt or PE.  Anesthesia feels it was the mestinon that I take for MG that caused a reaction with the anesthesia.  They have called this a Pulseless ELectrical Activity event due to mestinon.  My bp normally runs about 90/68 and pulse 48-54 but I have never been diagnosed with bradycardia.  I do have the hip to hip incision and all is healing well.  I would like to have my surgery completed in about 6 months but I am now afraid to go under general anesthesia.  I've never had this happen before and I've had many surgeries.  Two Thymectomy's, bunionectomy, tubal ligation, hernia repair C-section under epidural and a mastopexy.
Do you recommend TT using iv sedation or epidural or what are you thoughts on TT with sedation other than general?
I prefer IV sedation because when I had my C-section I was numb up to my chest with the epidural and I would be afraid my breathing could be compromised if I had and epidural for a prolonged period of time. It's really sad to have this huge incision and still have a large apron hanging over it.  Thank you in advance for your response

from Dr. Alan Engler

Dear Delisha,

I am so sorry for what you've gone through.

First of all, though, your overall safety has to be the priority.  The incision and scar are bad but a decision that could adversely affect your health is worse.  Any thoughts that I might have are pure speculation; you'll have to go over all of this with your own doctors, including internists, cardiologists, plastic surgeons, etc.  Whatever they decide is what you'll have to go with.  You can certainly seek some additional opinions but don't lose sight of the larger picture.

That being said, I would probably recommend an epidural over IV sedation alone, and that's with the assumption that it can be converted to general anesthesia if there is a problem with your airway.  That becomes the major concern, or at least among them, for a longer procedure.  A fleur-de-lis is a significant extension beyond the "regular" tummy tuck, and you have to all of those factors taken into consideration together.  It's harder to keep a large area "numb" using IV sedation alone than if an epidural is used, and therefore arguably safer with the epidural.  Maybe you can get the doctors to agree to try it one more time - but if they're unwilling to then you have to go with that, and recognize that they are trying to do what is best for you.

I hope that this helps and good luck,

Dr. Alan Engler

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Alan M. Engler, MD, FACS


Dr. Engler has answered over 6500 questions on social media sites, including over 3500 on AllExperts alone. His expertise includes breast surgery (breast enlargement with implants, breast reduction, breast lifts), liposuction, eyelid surgery, tummy tucks, facelifts, lipomas, skin cancers, cysts, etc. Dr. Engler has been listed as one New York`s Top Doctors, and as "One of the World's Most Famous Aesthetic Surgeons" (Aesthetic Surgery, TASCHEN Books, Angelika Taschen, Editor). He is the author of 4 books, including "BodySculpture" (a best-selling plastic surgery book on breast surgery, liposuction and tummy tucks), "EyeScapes" (Plastic Surgery of the Eyelids), "Restylane," and "The Slim Book of Liposuction." Dr. Engler has two US Patents for surgical instruments that he's designed, and has appeared on numerous television shows, including The Tyra Banks Show, The Ricki Lake Show (four times), the Dr. Keith Ablow Show and Jerseylicious. Videos of his appearances are available on YouTube (search for "DR. ENGLER"), and his discussion of breast implants, also on YouTube is "How to Choose a Breast Implant." His website is Follow Dr. Engler: @AlanEnglerMD


Dr. Alan Engler is a board-certified plastic surgeon in New York and the author of BodySculpture - Plastic Surgery of the Body for Men and Women (ISBN 0966382749) one of the top-selling plastic surgery books on,, as well as EyeScapes - Plastic Surgery of the Eyelids.

Dr. Engler graduated from Yale University (BA, Russian Studies) and the Columbia University College of Physicians and Surgeons (MD). He did his residency training in General Surgery and, after that, Plastic Surgery, at the Montefiore Medical Center in New York. He is on the faculty of the Albert Einstein College of Medicine in New York in the Departments of both Surgery (Plastic Surgery) and Medicine (Dermatology), and is a Special Lecturer in the Department of Dermatology at Columbia University in New York. He has admitting privileges at Beth Israel Medical Center and Montefiore Medical Center, both in New York.

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