Submuscular breast augmentation illustration

Thinking About Submuscular Breast Augmentation? Here’s What to Know About Tumescent Local Anesthesia

Mira Elwood in Health & Wellness August 2025 • 4 min read.

"Is tumescent local anesthesia (TLA) the right choice for your breast augmentation? Understand the benefits, risks, and what the experts are saying."

Breast augmentation is a transformative procedure, and choosing the right approach is key to achieving the desired results. One technique gaining attention is submuscular breast augmentation using tumescent local anesthesia (TLA). This method involves injecting a large volume of diluted local anesthetic into the breast tissue, combined with intravenous sedation to manage pain and anxiety. But is it the right option for you?

A recent study published in Aesthetic Plastic Surgery explored the outcomes of 300 patients who underwent partial subpectoral breast augmentation using TLA over a seven-year period. The results offer valuable insights into the safety and efficacy of this approach, sparking discussion among surgeons and patients alike.

This article delves into the details of TLA in breast augmentation, examining its benefits, potential drawbacks, and expert opinions to help you make an informed decision about your breast augmentation journey.

How Does Tumescent Local Anesthesia (TLA) Work in Breast Augmentation?

Submuscular breast augmentation illustration

The TLA technique involves a two-stage process. First, a tumescent solution is infiltrated into the prepectoral plane of each breast. This solution typically contains lidocaine (a local anesthetic), epinephrine (to constrict blood vessels and reduce bleeding), and bicarbonate (to balance the pH of the solution).

After about 40 minutes, the patient is moved to the operating room. There, under monitored anesthesia care provided by an anesthesiologist, intravenous midazolam is administered for sedation. Additional tumescent solution is then placed in the subpectoral space after incision. The procedure involves careful hemostasis (control of bleeding) and partial release of the pectoralis major muscle, with no drains typically placed.

Here’s a breakdown of the key components:

Tumescent Solution: A mixture of lidocaine, epinephrine, and bicarbonate in saline.
Two-Stage Infiltration: Initial injection in the holding area, followed by additional solution in the operating room.
Intravenous Sedation: Midazolam administered by an anesthesiologist for comfort and amnesia.
Subpectoral Placement: Implant positioned partially under the pectoralis major muscle.
No Drains: Emphasis on meticulous hemostasis to avoid the need for postoperative drains.

The study reported an average total operative time of 1 hour and 40 minutes for both stages. Textured silicone gel implants, both round and anatomic, were used in a range of volumes.

Is TLA Right for You?

Ultimately, the decision of whether or not to undergo submuscular breast augmentation with TLA is a personal one that should be made in consultation with a qualified and experienced plastic surgeon and anesthesiologist. Discuss your goals, concerns, and medical history to determine the most appropriate and safest approach for your individual needs.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1007/s00266-018-1275-y, Alternate LINK

Title: Discussion: Submuscular Breast Augmentation Using Tumescent Local Anesthesia

Subject: Surgery

Journal: Aesthetic Plastic Surgery

Publisher: Springer Science and Business Media LLC

Authors: Dennis C. Hammond

Published: 2018-12-10

Everything You Need To Know

How does Tumescent Local Anesthesia (TLA) work specifically during a breast augmentation procedure?

Tumescent Local Anesthesia (TLA) in breast augmentation involves a two-stage process. Initially, a tumescent solution composed of lidocaine (a local anesthetic), epinephrine (to constrict blood vessels), and bicarbonate (to balance the pH) is infiltrated into the prepectoral plane of each breast. After approximately 40 minutes, the patient is moved to the operating room where intravenous midazolam is administered for sedation. Additional tumescent solution is then placed in the subpectoral space post-incision. The procedure emphasizes careful hemostasis and partial release of the pectoralis major muscle, generally avoiding the use of drains.

What are the main advantages of using Tumescent Local Anesthesia (TLA) compared to traditional anesthesia methods in breast augmentation?

The key benefits of using Tumescent Local Anesthesia (TLA) in submuscular breast augmentation include enhanced patient comfort through intravenous sedation with midazolam, reduced bleeding due to the epinephrine in the tumescent solution, and the avoidance of postoperative drains through meticulous hemostasis. Furthermore, the study in *Aesthetic Plastic Surgery* suggests effectiveness and safety, indicating its potential as a viable option for patients.

What exactly is in the tumescent solution used during Tumescent Local Anesthesia (TLA) for breast augmentation, and what purpose does each component serve?

The tumescent solution used in Tumescent Local Anesthesia (TLA) for breast augmentation consists of a mixture of lidocaine, epinephrine, and bicarbonate in saline. Lidocaine acts as a local anesthetic to numb the area, epinephrine constricts blood vessels to minimize bleeding, and bicarbonate balances the pH of the solution to reduce discomfort during injection. The correct mixture of these components is crucial for the effectiveness and safety of the TLA technique.

How does Tumescent Local Anesthesia (TLA) support the submuscular aspect of breast augmentation, where the implant is placed partially under the muscle?

Submuscular breast augmentation involves placing the implant partially under the pectoralis major muscle. Utilizing Tumescent Local Anesthesia (TLA) supports this procedure by providing local anesthesia and reducing bleeding, which aids in the precise placement of the implant. The partial release of the pectoralis major muscle ensures the implant sits correctly while minimizing post-operative discomfort. However, it's important to note that techniques like total submuscular placement or other variations might influence the advantages and applicability of TLA, highlighting the need for personalized surgical planning.

What are the key takeaways from the Aesthetic Plastic Surgery study regarding Tumescent Local Anesthesia (TLA) in breast augmentation, and what related factors were not addressed?

The study published in *Aesthetic Plastic Surgery* highlighted the outcomes of 300 patients who underwent partial subpectoral breast augmentation using Tumescent Local Anesthesia (TLA) over a seven-year period. While the findings provide valuable insights into the safety and efficacy of this approach, other important factors not discussed include long-term capsular contracture rates, patient-reported aesthetic outcomes, and comparative analysis with alternative anesthesia techniques. These additional considerations are crucial for a comprehensive understanding of the pros and cons of TLA in breast augmentation.