Does a lumpectomy require general anesthesia (GA)?

Lumpectomy Anesthesia Options

Lumpectomy can be performed under either local anesthesia with sedation or general anesthesia, with the choice depending on several factors including extent of surgery, patient characteristics, and concurrent procedures. 1

Primary Anesthesia Options

• Local anesthesia with conscious sedation is a viable option for simple lumpectomy procedures without axillary node procedures 2, 3
• General anesthesia is increasingly being used for lumpectomy procedures, with rates rising from 66.7% to 82.5% between 2005 and 2019 4
• The choice between local and general anesthesia should be based on:
  • Extent of surgery (lumpectomy alone vs. with sentinel lymph node biopsy) 4, 5
  • Patient factors (obesity, ASA status) 4
  • Surgeon and patient preference 2

When Local Anesthesia with Sedation is Appropriate

• Simple lumpectomy without sentinel lymph node biopsy or axillary dissection 3
• Localized DCIS or invasive carcinoma less than 3 cm with clinically negative axillary nodes 3
• Patients who are good candidates for conscious sedation 2
• When intranasal dexmedetomidine (1.5 μg/kg) can be used as an adjunct to local anesthesia for optimal sedation without adverse effects 2

When General Anesthesia is Indicated

• Concurrent axillary procedures (sentinel lymph node biopsy or axillary lymph node dissection) significantly increase the odds of receiving general anesthesia 4
• Higher BMI and ASA class 3 patients more commonly receive general anesthesia 4
• More extensive breast surgeries beyond simple lumpectomy 4, 5
• Patient preference or anxiety 1

Practical Considerations

• For patients receiving general anesthesia, airway management should be carefully considered, especially in obese patients 1
• Multimodal analgesia approaches should be used regardless of anesthesia type 1
• Regional anesthesia techniques like Serratus Anterior Plane (SAP) blocks have not shown significant benefit for simple lumpectomy procedures without node biopsies 6
• If using sedation with local anesthesia, ensure appropriate monitoring and the presence of personnel capable of managing airway complications 1

Emerging Trends

• There has been an increasing trend toward general anesthesia use for lumpectomy procedures over the past decade 4
• Peripheral nerve block usage for breast surgery has increased since 2014, though absolute prevalence remains low (1.9% for lumpectomy and 13% for mastectomy by 2018) 5
• Patient demographics for lumpectomy are shifting toward older patients with higher BMI, which may partially explain the increasing use of general anesthesia 4

Risk Considerations

• Patients taking GLP-1 receptor agonists (like semaglutide) may have increased risk of regurgitation and pulmonary aspiration during general anesthesia, as reported in a case of semi-elective breast lumpectomy 1
• For patients with these risk factors who require general anesthesia, extended fasting times and additional precautions may be necessary 1