Anesthesia for Breast Surgery - An Overview

Introduction

Breast surgery is a common medical procedure performed for various reasons, including cosmetic enhancements, reconstruction after mastectomy, and addressing health issues. Regardless of the purpose, one of the critical components of any surgical procedure is anesthesia. Anesthesia ensures patients are comfortable, pain-free, and safe during the surgery. When it comes to breast surgery, specific considerations and techniques are employed to guarantee the well-being of the patient.

What Is Breast Surgery?

Breast surgery is a procedure that can be performed on the breasts of a woman or man. There are two main types of breast surgery: medical and cosmetic. Medical breast surgery is performed for medical reasons, such as to treat or prevent breast cancer. Some examples of medical breast surgery include:

• Lumpectomy or Mastectomy: This involves removing either part or all of the breast, as well as nearby lymph nodes, to treat breast cancer.

• Preventative Mastectomy: This involves removing the breasts to reduce the risk of breast cancer in people with a high genetic risk of the disease.

• Removal of Non-cancerous Breast Lumps: Some non-cancerous breast lumps may need to be removed for medical reasons, such as if they are large or causing pain.

• Breast Reduction: This involves reducing the size of the breasts to relieve pain or improve physical function.

Cosmetic breast surgery is performed for aesthetic reasons, such as to improve the appearance of the breasts. Some examples of cosmetic breast surgery include:

• Breast Reconstruction: This involves rebuilding the breasts after surgery for breast cancer.

• Breast Augmentation: This involves increasing the size of the breasts.

It is important to note that breast reduction can be performed for both medical and cosmetic reasons.

What Are the Anesthetic Options for Breast Surgery?

For most breast surgeries, anesthesia options are available, tailored to the specific surgical procedure, medical background, and preferences guided by the surgeon and anesthesiologist. The selection of anesthesia techniques is diverse and can be discussed in detail with the medical team for a comprehensive understanding.

• Intravenous Sedation: Intravenous sedation, also known as Monitored Anesthesia Care (MAC), involves the administration of sedatives through an IV (intravenous) line or a breathing mask. These sedatives are combined with a local anesthetic injected by the surgeon to numb the surgical area. The level of sedation can be adjusted, allowing patients to communicate with their doctors or experience partial sleep during the procedure. This combination of sedatives and local anesthesia effectively ensures comfort, especially for minor breast surgeries like biopsies or the removal of breast lumps.

• Regional Anesthesia: Regional anesthesia involves numbing only the specific body area where surgery is performed, making the surrounding tissues insensitive to pain. This technique differs from general anesthesia, which renders the entire body pain-free. To enhance patient comfort, regional anesthesia is often combined with intravenous sedation. Alternatively, both regional and general anesthesia might be used in some cases. Regional anesthesia provides extended pain relief after surgery. There are three primary types of regional anesthetics used for breast surgeries: thoracic epidural anesthesia, paravertebral blocks, and intrathecal morphine.

1. Thoracic Epidural Anesthesia: Thoracic epidural anesthesia, a technique commonly associated with pain relief during childbirth, is also utilized for various surgical procedures, including breast surgery. Unlike childbirth epidurals placed in the lower back, those for breast surgery are positioned higher, between the shoulder blades. A small catheter is inserted into the epidural space, which houses the nerves to be numbed for surgery. Local anesthetic is delivered through the catheter, rendering the surgical area painless until the effects wear off. If the catheter remains in place, this method provides prolonged pain relief after surgery. It is especially beneficial for extensive procedures like mastectomies with reconstruction, requiring extended hospitalization.

Occasionally, it is also used for procedures that do not need a post-surgery hospital stay. However, once the epidural catheter is removed, pain relief will diminish within hours. At that point, alternative pain management methods, usually oral medications prescribed by the surgeon before discharge, become necessary.

1. Paravertebral Blocks: Paravertebral blocks are an alternative form of regional anesthesia used in breast surgery. Similar to thoracic epidural anesthesia, this technique involves injecting a local anesthetic into the back, numbing the chest area by targeting specific nerves. However, unlike thoracic epidural anesthesia, paravertebral blocks do not require the placement of catheters in the back. Instead, multiple injections of local anesthetic are administered along the back of the ribcage. This method, combined with intravenous sedation, selectively numbs the nerves on the side of the chest where the surgery will take place. One significant advantage of paravertebral blocks is their longer-lasting effect, typically relieving pain for 18 to 24 hours or more. This makes them especially popular for patients undergoing partial or complete mastectomies, allowing them to return home on the same day of surgery. Additionally, patients receiving regional anesthesia, including paravertebral blocks, often experience lower rates of post-surgery nausea compared to other anesthesia methods.

1. Intrathecal Morphine: Intrathecal Morphine is a type of pain medication that is injected into the spinal canal. It is used in combination with general anesthesia for patients undergoing mastectomies with flap reconstructions. This type of surgery involves removing the breast and rebuilding it using tissue from another part of the body. Intrathecal Morphine is different from a spinal anesthetic because it does not cause paralysis in the lower body. Instead, it provides long-lasting pain relief, typically lasting for 18 to 24 hours or more. Intrathecal morphine is a powerful medication, so it is only used for patients who will be in the hospital after surgery. This is because it can depress breathing for a few hours after administering it.

• General Anesthesia: General anesthesia is the most common type of anesthesia used for breast surgery. It is a medication that puts a patient completely asleep during surgery. General anesthesia is often combined with a local anesthetic to reduce pain at the incision site. Sometimes, a form of regional anesthesia will also be used. General anesthesia is started with medicine given through an IV or a breathing mask. Patients are much less likely to be sleepy after the initial recovery time than in the past. There are also many new effective approaches to control postoperative problems, such as nausea and vomiting. Some day-surgery patients feel well enough to go directly from the operating room to a reclining chair in the recovery lounge. Most day-surgery patients are moved to recovery with minimal discomfort from nausea, vomiting, or pain.

If a patient is in the hospital overnight after their procedure, pain relief is usually provided by an Intravenous (IV) pump called an IV-PCA. This stands for Intravenous Patient-Controlled Analgesia. The nurses in the recovery room will start this pump after surgery and teach the patient how to use it properly. The pump is set so the patient can receive a certain amount of medicine every five to seven minutes.

Conclusion

Anesthesia is a critical component of breast surgery, ensuring patient comfort and safety during the procedure. Various anesthesia options are available, tailored to the specific surgical procedure, medical background, and preferences. The most common type of anesthesia used for breast surgery is general anesthesia. However, regional anesthesia, such as paravertebral blocks, thoracic epidural anesthesia, and intrathecal Morphine, are also commonly used. Selecting the most appropriate anesthesia technique is a collaborative decision between the surgeon and anesthesiologist. Factors such as the type of surgery, patient's medical history, and preferences are all considered.