What types of anesthesia are used during breast surgery?
"Anesthesia varies widely depending on the type of surgery,” says Dr. Kurup. Some patients get local anesthesia at the site of the incision and just enough sedation to be comfortable and pain-free during surgery. Others receive general anesthesia for more complex surgeries.
During a lumpectomy, most of the breast tumor is removed, along with some tissue around it, leaving the rest of the breast intact. Most patients can get by with light sedation (given through an intravenous, or I.V., line in the arm or hand) and local anesthetic to numb the breast. But depending on the extent of the surgery and your comfort level, you may prefer heavier sedation or general anesthesia.
For mastectomy (removal of one or both breasts), lymph node dissection (removal of lymph nodes under your arm) and breast reconstruction, general anesthesia is required. It is administered through an I.V. line and a breathing tube and the anesthesiologist continuously monitors vital signs.
What are some of the after-effects of anesthesia during breast surgery?
We use every method available to minimize the nausea and vomiting that are common after surgery. “If the patient has certain risk factors such as a history of motion sickness or nausea after previous surgeries, we give preventative medications through their I.V. so they wake up with fewer side effects,” Dr. Kurup says.
Even with these precautions, however, some patients will still have nausea and vomiting, and quick-relief medications (also known as rescue medications) can be provided post-op. “After patients wake up in the recovery room, there is constant assessment and monitoring to make sure they are pain-free, nausea-free, breathing well and comfortable,” Dr. Kurup says, noting that it usually takes between one and one-and-a-half hours for grogginess to go away.
Do patients have a choice in what type of anesthesia is used?
For surgeries in which general anesthesia is not necessary, we invite you to tell us what level of sedation you feel most comfortable receiving. “It’s a shared decision among the anesthesiologist, the surgeon, and the patient,” Dr. Kurup says. “This is so we can provide patients with the best options and care."
You will be invited to a pre-op clinic about two weeks before your surgery, where you can meet with an anesthesiologist who will explain the benefits and risks of each option, allowing time for you to go home and think about which level of sedation would be best for you. On the morning of the surgery, you will discuss a plan with the anesthesiologist attending the surgery.
How is the anesthesia plan personalized?
"There is not one single medication that puts all patients to sleep for surgery," Dr. Kurup says. “There is such a wide variety of medications available, and certain ones are better for patients with conditions such as heart disease, asthma or liver disease.”
Most patients receive a combination of several medications. “The choice is very individual—no two patients will get the same exact drugs at the same exact dose,” Dr. Kurup says.
How does the anesthesiologist help manage postoperative pain?
Because breast surgery can cause postoperative pain in the chest and under the arm, from which lymph nodes may have been removed, anesthesiologists often use a method of regional anesthesia called a paravertebral block.
In this treatment, anesthetics are injected into the patient’s back or side to block the nerves from sending pain signals to the brain. These blocks can last for up to 24 hours after surgery, and because the drugs are not absorbed systemically (throughout the body), they cause less nausea and other side effects.
One particular challenge with breast surgery is that patients often suffer chronic postoperative pain, Dr. Kurup says. Anesthesiologists at Yale Medicine are working with surgeons to investigate the use of different medications that may decrease the number of patients dealing with chronic pain. "It is something we feel is very important, and we are keen to offer patients solutions,” she says.
What is unique about Yale Medicine’s approach to anesthesia during breast surgery?
In addition to continually refining the most effective methods for decreasing postoperative pain, our anesthesiology team stands out for its close, collaborative relationship with Yale Medicine's breast surgeons.
“We have a very dedicated group of anesthesiologists and surgeons who work very well together,” Dr. Kurup says. “Everybody is committed to making sure the patient has the best care and the best experience possible. We take a lot of pride in that.”