Anesthesia Expectations for Mastectomy Surgery (with or without reconstruction)
- Jen Overton
- Dec 31, 2024
- 7 min read
Updated: Sep 22
Facing a mastectomy can feel overwhelming, and it’s natural to have questions or concerns about anesthesia. Cancer is an awful disease and the feelings that accompany a cancer diagnosis can be a lot to handle. It’s incredibly important to feel informed and supported throughout this process.
You've likely met your surgeon and discussed the procedure, but the anesthesia team often meets you on the day of surgery. This can make anesthesia feel like an unknown, which may add to your anxiety. My goal as a nurse anesthetist is to walk you through what to expect on the day of your surgery, explain the anesthesia methods commonly used for this procedure, and provide clear, honest information to help ease your mind. Let’s break it down together.
Why Anesthesia for Mastectomy Matters
Anesthesia is a critical part of your mastectomy, ensuring you’re comfortable, pain-free, and safe during the procedure. For this surgery, two types of anesthesia are often used together: general anesthesia and an erector spinae plane (ESP) block.
General anesthesia keeps you asleep and unaware during surgery, while the ESP block targets pain relief in the chest and surrounding areas, often reducing discomfort after you wake up. By combining these methods, your anesthesia team aims to make your experience as smooth and pain-free as possible.
Below, I’ll explain what happens on the day of surgery, how these anesthesia methods work, and what you might feel, so you can approach your procedure with more knowledge and a feeling of control.
Worried about surgery day? Click the image below to read How Can I Keep Myself Safe Under Anesthesia?
Your Day-of-Surgery Anesthesia Experience
Before Surgery: Meeting Your Anesthesia Team
On the morning of your surgery, you’ll arrive at the hospital and check in to the preoperative area. Here, you’ll meet your anesthesia provider—likely a nurse anesthetist like me or an anesthesiologist. We’ll review your medical history, discuss any medications you take, and answer any questions you have. This is also when we confirm the anesthesia plan, tailored to your needs and the surgeon’s approach.
You’ll likely feel a mix of emotions, and that’s okay. We’re here to listen and explain everything in a way that makes sense. If you’re nervous, let us know—we can offer reassurance or, in some cases, a mild sedative to help you relax before heading to the operating room.
The Erector Spinae Plane (ESP) Block: What to Expect
Before you go to sleep under general anesthesia, your anesthesia team may perform an ESP block to help manage pain during and after surgery. This is a type of regional anesthesia, meaning it numbs a specific area of your body (in this case, the chest and nearby tissues) without affecting your whole body.
Purpose of the ESP Block
The ESP block reduces pain in the surgical area, which can make your recovery more comfortable. By numbing the nerves around your chest, it decreases the need for strong pain medications (like opioids) after surgery, which can help you feel more alert and reduce side effects like nausea.
The Process
The ESP block is typically done in the preoperative area, before general anesthesia. Here’s what happens:
Positioning: You’ll sit up, similar to getting an epidural. We’ll help you get comfortable and guide you through each step.
Cleaning and Numbing: We clean the skin on your back (near your shoulder blade) with a cool antiseptic solution. Then, we inject a small amount of local anesthetic to numb the skin, which feels like a quick pinch or sting that fades in seconds.
Ultrasound Guidance: Using an ultrasound machine (like the one used for pregnancy scans), we locate the exact spot to place the block. You won’t feel the ultrasound—it’s just a wand that glides over your skin.
Placing the Block: We insert a small needle to deliver the numbing medication near the erector spinae muscle, which is close to the nerves that supply sensation to your chest. You might feel slight pressure, but it shouldn’t be painful. The process takes about 5–10 minutes.
What You’ll Feel: After the block, you may notice a warm or heavy sensation in your chest or shoulder area as the numbing takes effect. This is normal and means the block is working.
The ESP block is safe and effective, and we monitor you closely throughout. If you’re worried about needles, don’t hesitate to tell us—we can distract you with conversation or explain each step to keep you at ease.
Want to learn even more about the Erector Spinae block for your surgery? Click the image below for more info.
General Anesthesia: What to Expect
Once the ESP block is in place (if used), we’ll take you to the operating room for general anesthesia, which ensures you’re fully asleep and unaware during the surgery.
Purpose of General Anesthesia
General anesthesia allows your surgeon to perform the mastectomy and reconstruction while you’re completely comfortable, with no memory or sensation of the procedure. It also helps us control your breathing and vital signs to keep you safe.
The Process
Getting Started: In the operating room, you’ll lie on a padded table, and we’ll place monitors on you to track your heart rate, oxygen levels, and blood pressure. These are standard and noninvasive, like sticky patches or a clip on your finger.
Falling Asleep: We’ll give you oxygen through a mask that rests gently over your nose and mouth. Then, we’ll administer anesthesia medication through your IV. Within seconds, you’ll drift off to sleep—it feels like closing your eyes for a nap.
During Surgery: While you’re asleep, we place a breathing tube to help you breathe safely. You won’t feel or remember this, as it’s done after you’re fully asleep. We monitor you continuously, adjusting medications to keep you stable and comfortable.
Waking Up: After surgery, we stop the anesthesia medications, and you’ll wake up in the recovery room. The breathing tube is usually removed before you’re fully awake, so you won’t notice it. You may feel groggy or sleepy, but we’ll be there to help you feel oriented.
Want to learn more about general anesthesia? Click the image below to read General Anesthesia: The Patient Experience from Start to Finish.
What You’ll Feel
When you wake up, the ESP block (if used) may make your chest feel numb or less painful, though you might still have some discomfort. The recovery room nurses will give you pain medication as needed and ensure you’re comfortable. You might feel a bit chilly, thirsty, or have a sore throat from the breathing tube, but these issues are temporary and manageable.
Why This Combination Works
Using general anesthesia with an ESP block is a powerful approach for mastectomy with reconstruction. The general anesthesia ensures you’re asleep and unaware during the procedure, while the ESP block targets pain at the surgical site, often reducing the intensity of discomfort in the first few days of recovery. This combination can help you feel more like yourself sooner, with less reliance on pain medications that might make you feel drowsy or nauseated.
Alternative Anesthesia Options
While general anesthesia with an ESP block is common for mastectomy with reconstruction, other approaches might be considered based on your health, the extent of the surgery, or your preferences. For example:
General Anesthesia Alone: If an ESP block isn’t suitable (e.g., due to specific medical conditions), general anesthesia can still provide complete comfort during surgery, with pain managed afterward using oral or IV medications.
Thoracic Epidural: In some cases, an epidural catheter placed in the upper back can provide continuous pain relief for the chest area, similar to the ESP block. This might be used for more extensive reconstructions or if you’re staying in the hospital for a few days.
Your anesthesia provider will work with you and your surgeon to choose the best option, considering your medical history and the specifics of your procedure. If you have preferences or concerns (e.g., wanting to avoid certain medications), share them during your preoperative discussion—we’re here to personalize your care.
Tips to Prepare and Reduce Anxiety
Knowing what to expect can make a big difference in how you feel going into surgery. Here are a few ways to prepare:
Ask Questions: Write down any questions about anesthesia and bring them to your preoperative appointment or ask on the day of surgery. No question is too small.
Focus on Breathing: If you feel nervous, try slow, deep breaths to calm your mind. We can also guide you through relaxation techniques if needed.
Trust Your Team: Your anesthesia team is trained to keep you safe and comfortable. We’ll be with you every step of the way, monitoring you closely and adjusting care as needed.
Plan for Recovery: Arrange for a friend or family member to support you after surgery, and ask your surgeon or anesthesia provider about what to expect during recovery.
Are you still worried about anesthesia for your mastectomy? Click the image below to read How to Overcome the Fear of Anesthesia: Tips for a Better Surgical Experience and access our FREE printable Preoperative Checklist for Anesthesia.
Final Thoughts
Navigating the path of a mastectomy can be challenging, but understanding your anesthesia options can empower you on this journey. Anesthesia for a mastectomy is designed to keep you safe, comfortable, and pain-free, allowing your surgeon to focus on the procedure while we focus on you.
By understanding the process—meeting your anesthesia team, receiving an ESP block, and experiencing general anesthesia—you can feel more prepared and less anxious. My hope is that this information empowers you to approach your surgery with more confidence and control over your body and an assurance that your anesthesia team is dedicated to your care.
Feel free to re-read this article leading up to your surgery day. Close your eyes and visualize the process and practice observing what is happening and appreciating the expertise of those whose purpose lies in caring only for you.
If you have more questions or want to learn about anesthesia for other procedures, explore this website or reach out to your healthcare team. I'm here to support you on this journey because prepared patients have better outcomes.
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**Information provided is intended as general healthcare information for the public and should be used as a guide. This information should not be substituted for the specific personal advice recommended by your own healthcare team who are familiar with your specific health history.*