Is a lumpectomy for breast cancer done with a local or general anesthesia?

Twilight: I perform lumpectomies under local anesthesia supplemented by IV sedation ("twilight" anesthesia). When performing lumpectomies for breast cancer, i usually will perform a sentinel lymph node biopsy at the same time. Depending on the patient, this is commonly performed under twilight or general anesthesia. Regardless, this is out-patient surgery with a very short recovery time.

Anesthsia: In my practice, I use a heavy sedation (also known as mac) with local or general anesthesia. It depends on how extensive the mass and if i need to do a procedure on the lymph nodes. With proper pre operative physical exam, the risk for anesthesia can be assessed and the appropriate method can be selected. It is important to be comfortable so the surgeon can complete the procedure safely.

Either or both: Most often, the surgeon will inject some local anesthesia and the anesthesiologist will give some sedation as well. Sometimes general anesthesia is needed due to the specific health problems of the patient, or the location of the tumor. A tumor deep within a breast requires more anesthesia than one that is close to the skin. Talk to the anesthesiologist and surgeon about the options.

Depends on pt: Lumpectomy alone is fine under local with sedation added. Pts usually fall asleep but don't need to be "put" to sleep with breathing tube & paralysis. When sentinel node bx is added, we usually opt for general (intubated or laryngeal mask if anesth will do it) since it's longer and the axilla & behind the muscle is harder to access & numb. Regional block is feasible but rarely offered by anesth.

Usually sedation: This is usually done under local anesthesia with IV sedation. If there is going to be a lymph node dissection as well then the anesthetic may be increased to a general.