Can You Have a Breast Reduction While You're Awake?

I get asked this all the time, and the simple answer is absolutely yes.

It's not my personal preference, but awake surgery is a real, legitimate option performed by surgeons who specialize in it. Here's how it actually works and what you should ask about before signing up.

A lot of procedures can be done without general anesthesia, meaning you're awake and chatting with us during the operation.

The trade-off is where the work shifts. Without an anesthesiologist keeping you comfortable under general anesthesia, I have to do extra work as the surgeon to numb the area thoroughly.

Surgeons doing awake procedures typically use a dilute numbing solution called tumescent.

This is the part I'd want any patient to know before choosing an awake procedure.

Local anesthetic toxicity is a real phenomenon, and the ceiling is a dose ceiling. A large breast reduction covers a lot of territory, which means a lot of tumescent.

Which leads to the single most important piece of advice here:

If you're going to do this, go to a surgeon who is very familiar with the method. This is not something to try with someone who does it occasionally.

There's a comfort dimension that people underestimate.

Even if you're completely numb and pain-free, you tend to tire out during a long procedure. It is simply not fun to be worked on for many hours while awake, regardless of how good the anesthesia is.

And breast reduction is a genuinely lengthy operation. Larger reductions can take several hours in the operating room, for two reasons:

• The reduction itself takes time
• The incision is quite large and takes real time to close

If you're considering an awake breast reduction, these are the questions I'd push on:

Surgeons doing awake procedures frequently have support staff present specifically to support you as the patient, not to assist the operation. Someone whose job is you.

I think that's really helpful. Make sure your surgeon has it.

This one is practical and rarely mentioned. Because the incision for a reduction is long and closing takes a while, ask whether your surgeon has an assistant helping them close.

Two people closing means the swiftest possible surgery, which for an awake patient translates directly into more comfort and less time spent tiring out on the table.

If an awake breast reduction genuinely interests you, I'd highly recommend checking out the account of my colleague Dr. Meegan Gruber. She is an absolute master at awake surgery, and you'll get a lot of interesting tips and information from her that go well beyond what I can offer, since it isn't my own preferred approach.

• Yes, you can have a breast reduction while awake. It just isn't my personal preference.
• It relies on tumescent, a dilute numbing solution, and the surgeon does considerably more anesthetic work.
• Tracking the total dose is a genuine safety issue, since these medications are unsafe above certain levels. Choose a surgeon experienced with the technique.
• Long operations tire awake patients out even when they're comfortable, and larger reductions run several hours.
• Ask about support staff for you and an assistant for the closure to keep the operation as short as possible.

Awake surgery is a legitimate option in the right hands with the right setup. The questions above are how you find out whether you're in them.