Is it really possible to be awake during breast surgery with only local anesthesia?

Question

I was told by a surgeon, "I can't have you awake during this procedure." I was just reading a review where someone said, the surgeon was, "kind during the surgery. A couple of times when I felt pain he immediately injected more local and reminded me..." I had no idea that there was any such thing. I've watched several breast reductions on the web and every one of them was asleep. If I get breast reduction, can I be awake during the process and does this just depend on the surgeon and on my own choice?

Shwetambara Parakh, MD · Answer

Breast reduction can be done under IV sedation with local anesthesia. Completely awake traditional breast reduction is not doable.

Jacqueline Anne Luong, MD · Answer

This procedure is generally done under general anesthesia.  If it is being done under local anesthesia, I would be concerned that I would "run out of local" before the procedure is done.  The amount of local anesthesia that can be injected is limited based on the patient's body weight.  If I have injected the "allowed amount" but the patient still has pain .. then what???  Also, I suspect if it is being done under local anesthesia it may be being done by someone who does not have privileges in the operating room, ie a non surgeon.  Do your homework before signing up for such a procedure under local anesthesia.Dr. Luong

Susan MacLennan, MD · Answer

Hello and thanks for your question-Breast reduction is nearly always done under general anesthesia. It would be difficult to get the whole area numb enough to keep a patient comfortable without general anesthetic - the area I treat includes not only the breast but also the sides of the chest and the area in front of the armpits (liposuction). Too much area to rely on local alone. I like to be able to concentrate on the operation and not be worrying about causing pain to the patient or having her pain limit what I can do.Breast augmentation is occasionally done under local with sedation, so perhaps the review you read was for augmentation rather than reduction.Please discuss your wishes with your surgeon, but be aware that general anesthesia is likely to be the recommendation.Best wishes-

Steven Wallach, MD · Answer

I have only performed breast reductions under anesthesia and I think that is the most pain free way to go.

Kenneth R. Francis, MD, FACS · Answer

Dear Nimrin,Breast reduction under local anesthesia is rarely performed and is usually reserved for patients that are too ill to tolerate general anesthesia.  Even in that population, the issue of why a breast reduction is needed at all would apply.  In addition, it is very difficult for an awake patient to sit still for the amount of time that a breast reduction takes.  Good luck!

Tom J. Pousti, MD · Answer

Thank you for the question. Although breast reduction can (and is) performed under local anesthesia with sedation, this would not be my preference or recommendation.  I find that the use of general anesthesia provided by a board-certified anesthesiologist provides for optimal patient comfort, immobility, experience, and outcomes.Best wishes.

Robert L. Kraft, MD, FACS · Answer

Breast reduction is performed under general anesthesia.  Local alone is completely inconceivable to me.  The extent of the surgery and length of the operation necessitate appropriate anesthesia.

Lawrence Bundrick, MD (retired) · Answer

Any type of breast surgery, whether it is a reduction, lift or augmentation is performed under general anesthesia. You would not be even given the choice.

Is it really possible to be awake during breast surgery with only local anesthesia?

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