Breast surgery is performed for cosmetic reasons, benign lump excision, abscess draining, and breast cancer treatment (Sherwin & Buggy, 2018). Awake breast surgery, a procedure that allows patients to remain conscious during breast surgery, has increased in popularity over recent years. In the past, surgeries necessitated general anesthesia and intubation, but many procedures can now be performed on awake patients with local anesthesia and sedation, including some types of breast surgery (Vanni et al., 2023). This is possible due to innovations and new discoveries in the field of anesthesia and allows patients to participate more in their procedures. Awake breast surgery can be performed for cases of breast surgery both related and unrelated to breast cancer.
Breast surgeries were traditionally conducted under general anesthesia, rendering patients’ unconscious throughout the entire procedure. However, in some types of breast surgery, general anesthesia is now unnecessary and awake surgery is gaining traction, such as in breast-conserving surgery and breast biopsies. General anesthesia poses its own risks that must be considered. Studies show that volatile anesthetics used during general anesthesia can interfere with the immune system and stimulate a surgical stress response (Vanni et al., 2023). However, awake breast surgery is not suitable for all patients or procedures. Eligibility of a patient depends on a variety of risk factors and the surgery a patient requires.
Anesthesia for awake breast surgery typically involves local anesthesia combined with sedation. The local anesthetic numbs the surgical area, while sedative medications help the patient relax and alleviate anxiety. There are several anesthesia techniques that can be used for breast surgery on awake patients. For instance, a thoracic paravertebral block can be used. The most substantial evidence supporting thoracic paravertebral blocks for breast surgery is in a quadrantectomy with or without lymphadenectomy (Vanni et al., 2023). In breast augmentation, an intercostal nerve block and tumescent anesthesia can be used and has been employed, and has been associated with increased patient satisfaction and reduced blood loss. However less is known about this technique in terms of hospital time and postoperative pain (Shimizu et al., 2014). Other options for awake breast surgery include the serratus anterior plane block, cervical spinal anesthesia, and double epidural technique, with the choice depending on the specific surgery (Vanni et al., 2023).
Awake breast surgery offers several benefits to both patients and medical professionals. With awake breast surgery, patients may experience less psychological and physical stress (Vanni et al., 2023). There are also many benefits for surgeons and hospitals, including decreased length of stay, reduced costs, and overall increased overall efficiency and productivity (Vanni et al., (2023).
Even recently, awake breast surgery had a crucial role during the COVID-19 pandemic. Cancer-related surgeries could not be delayed or cancelled due to risk of progression of breast cancer. Awake breast surgery allowed for a shorter hospital stay and minimized the number of beds occupied by non-COVID-19 patients, leaving more beds and resources to patients with COVID-19 (Vanni et al., 2021).
In summary, awake breast surgery, when clinically appropriate, is a patient-centered approach to surgical procedures that does not involve the stresses of general anesthesia. There are numerous benefits to both the patient, surgeon, and hospital system. However, this procedure is not applicable for every patient or procedure, and each patient requires an individual plan for surgery and anesthesia. While there are evident benefits in terms of economic sustainability, postoperative recovery, and hospital stay, further research is needed to understand the impact on the immune system and tumor progression with local forms of anesthesia (Vanni, et al., 2023).
References
Sherwin, A, and D J Buggy. “Anaesthesia for breast surgery.” BJA education vol. 18,11 (2018): 342-348. doi:10.1016/j.bjae.2018.08.002
Shimizu, Yusuke et al. “Combined usage of intercostal nerve block and tumescent anaesthesia: an effective anaesthesia technique for breast augmentation.” Journal of plastic surgery and hand surgery vol. 48,1 (2014): 51-5. doi:10.3109/2000656X.2013.800529
Vanni, Gianluca et al. “Awake breast cancer surgery: strategy in the beginning of COVID-19 emergency.” Breast cancer (Tokyo, Japan) vol. 28,1 (2021): 137-144. doi:10.1007/s12282-020-01137-5
Vanni, Gianluca et al. “Awake Breast Surgery: A Systematic Review.” In vivo (Athens, Greece) vol. 37,4 (2023): 1412-1422. doi:10.21873/invivo.13225