General Anaesthesia
Most breast augmentation and reconstruction procedures use general anaesthesia — the patient is completely unconscious for the duration of surgery. General anaesthesia is administered intravenously and maintained with inhalational agents. Modern general anaesthesia in healthy patients is extremely safe: the risk of anaesthetic death in elective surgery in healthy patients is estimated at approximately 1 in 100,000–200,000. Side effects including nausea, vomiting, and sore throat are common; serious complications are rare.
Sedation (MAC Anaesthesia)
Some smaller breast procedures — fat transfer, minor revision, some explantations — can be performed under monitored anaesthesia care (MAC) with sedation and local anaesthetic injection rather than full general anaesthesia. The patient is in a sedated, twilight state rather than fully unconscious. Recovery is typically faster and there is less post-operative nausea. MAC is only appropriate for procedures where the surgical field can be adequately anaesthetised with local injection.
Regional Nerve Blocks
Paravertebral blocks and serratus anterior plane blocks are increasingly used as adjuncts to general anaesthesia in breast surgery to provide extended post-operative pain control. The anaesthesiologist injects local anaesthetic near the relevant nerve roots or fascial planes to provide 12–24 hours of additional pain relief, reducing the opioid requirement post-operatively. This is particularly valuable for submuscular augmentation where pectoralis muscle pain is significant.
Pre-operative Assessment
Before any breast surgery under general anaesthesia, patients undergo pre-operative medical assessment including: blood tests, ECG (in older patients), anaesthetic questionnaire covering allergies and previous anaesthetic reactions, medication review (particularly blood thinners and supplements), and fasting instructions. Patients are typically asked to fast from solid food for 6–8 hours before surgery.
