Illustration of tumescent anesthesia in breast augmentation

Considering Submuscular Breast Augmentation? Here’s What You Need to Know About Tumescent Local Anesthesia

Kai Mendoza in Health & Wellness August 2025 • 4 min read.

"A closer look at the safety, efficacy, and patient experience with tumescent local anesthesia in submuscular breast augmentation."

Breast augmentation is a popular cosmetic procedure for women seeking to enhance their breast size and shape. While traditional methods often involve general anesthesia, recent advancements have introduced tumescent local anesthesia (TLA) as a promising alternative. This technique, combined with intravenous sedation, aims to provide a more comfortable and less risky experience for patients undergoing submuscular breast augmentation.

A study published in Aesthetic Plastic Surgery journal delves into the outcomes of using TLA in a series of 300 patients. Conducted over seven years, the research explores the safety, efficacy, and patient satisfaction associated with this approach. By understanding the nuances of TLA, women can make more informed decisions about their breast augmentation journey.

This article breaks down the key findings of the study, offering a comprehensive overview of TLA in submuscular breast augmentation. From the preparation process to potential complications, we'll cover everything you need to know to determine if this technique aligns with your personal preferences and health considerations.

What is Tumescent Local Anesthesia (TLA) and How Does It Work?

Illustration of tumescent anesthesia in breast augmentation

Tumescent local anesthesia involves injecting a large volume of dilute anesthetic solution into the targeted area. This solution typically contains lidocaine, a local anesthetic, along with epinephrine to constrict blood vessels and minimize bleeding. Bicarbonate is also added to neutralize the pH of the solution which reduces the burning sensation of lidocaine. The fluid-filled tissue becomes firm and swollen, hence the term "tumescent."

In the context of submuscular breast augmentation, TLA serves a dual purpose: it numbs the area to reduce pain during the procedure and creates space between tissues, making it easier for the surgeon to create the pocket for the breast implant.

Stage 1 Infiltration: Involves injecting an average of 520 cc of tumescent solution (containing lidocaine, epinephrine, and bicarbonate in normal saline) into the prepectoral plane of each breast while the patient is in the holding area.
Stage 2 Anesthesia: Patient is transferred to the operating room, where intravenous midazolam is administered as an amnestic agent under monitored anesthesia care by an anesthesiologist.
Subpectoral Injection: Following incision, an additional 180-240 cc of the same tumescent solution is placed in the subpectoral space in each breast.

This method ensures patient comfort during the procedure. The study emphasizes the importance of having an anesthesiologist present to monitor the patient's cardiovascular health, especially given the potential effects of lidocaine and Midazolam on cardiac function.

Is Tumescent Local Anesthesia Right for You?

Ultimately, the decision of whether to undergo submuscular breast augmentation with tumescent local anesthesia is a personal one. By understanding the details of the technique, potential benefits, and associated risks, you can have a more informed conversation with your plastic surgeon and determine the best approach for your individual needs and preferences.

About this Article -

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Everything You Need To Know

What is tumescent local anesthesia (TLA), and what purpose does it serve in submuscular breast augmentation?

Tumescent local anesthesia (TLA) involves injecting a large volume of dilute anesthetic solution, typically containing lidocaine, epinephrine, and bicarbonate, into the targeted area. In submuscular breast augmentation, TLA numbs the area to reduce pain during the procedure. It also creates space between tissues, which makes it easier for the surgeon to create the pocket for the breast implant. The epinephrine constricts blood vessels to minimize bleeding, and the bicarbonate neutralizes the pH of the solution, which reduces the burning sensation of lidocaine. The fluid-filled tissue becomes firm and swollen.

What are the stages of tumescent local anesthesia (TLA) infiltration during submuscular breast augmentation, and what happens in each stage?

Tumescent local anesthesia (TLA) infiltration during submuscular breast augmentation involves distinct stages. In Stage 1 Infiltration, an average of 520 cc of tumescent solution, containing lidocaine, epinephrine, and bicarbonate in normal saline, is injected into the prepectoral plane of each breast while the patient is in the holding area. In Stage 2 Anesthesia, the patient is transferred to the operating room, where intravenous midazolam is administered as an amnestic agent under monitored anesthesia care by an anesthesiologist. Following incision, an additional 180-240 cc of the same tumescent solution is placed in the subpectoral space in each breast during the Subpectoral Injection stage.

What are the potential benefits and risks associated with using tumescent local anesthesia (TLA) for submuscular breast augmentation?

The use of tumescent local anesthesia (TLA) for submuscular breast augmentation offers the benefit of a more comfortable and less risky experience, as an alternative to general anesthesia. It numbs the targeted area, minimizing pain during the procedure, and creates space between tissues to facilitate implant placement. However, potential risks include the cardiovascular effects of lidocaine and midazolam, which is why the presence of an anesthesiologist is crucial for monitoring the patient's cardiovascular health.

Aesthetic Plastic Surgery journal published a study on TLA in submuscular breast augmentation, what did the study focus on?

The study published in Aesthetic Plastic Surgery journal focused on the outcomes of using tumescent local anesthesia (TLA) in a series of 300 patients over seven years. The research explored the safety, efficacy, and patient satisfaction associated with this approach in submuscular breast augmentation. It provided a comprehensive overview of TLA, from the preparation process to potential complications, to help women make informed decisions about their breast augmentation journey.

Why is the presence of an anesthesiologist important during submuscular breast augmentation with tumescent local anesthesia (TLA)?

The presence of an anesthesiologist is important during submuscular breast augmentation with tumescent local anesthesia (TLA) because they monitor the patient's cardiovascular health. This is especially crucial given the potential effects of lidocaine and midazolam on cardiac function. The anesthesiologist ensures patient safety and manages any potential complications related to the anesthesia during the procedure.