Aesthetic Plastic Surgery

, Volume 43, Issue 1, pp 7–13 | Cite as

Sub-muscular Breast Augmentation Using Tumescent Local Anesthesia

  • Alberto BollettaEmail author
  • Luca Andrea Dessy
  • Luca Fiorot
  • Alessio Tronci
  • Antonio Rusciani
  • Pedro Ciudad
  • Emilio Trignano
Original Article Breast Surgery



Tumescent local anesthesia (TLA) consists of infiltration of saline solution with lidocaine and epinephrine into the tissues to obtain regional anesthesia and vasoconstriction. The use of TLA in augmentation mammoplasty has been described for sub-glandular positioning. We describe a modified TLA technique for primary sub-muscular breast augmentation reporting our experience during the past 7 years.


From 2010 to 2017, 300 patients underwent bilateral primary sub-muscular breast augmentation under TLA and conscious sedation. The tumescent solution was prepared with 25 mL of 2% lidocaine, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) in 1000 mL of 0.9% saline solution. Firstly, the solution was infiltrated between the pectoral fascia and the mammary gland, secondarily, during surgery, under the pectoralis major muscle.


The average amount of tumescent solution infiltrated while performing TLA was 740 mL per breast. No signs of adrenaline or lidocaine toxicity were reported and conversion to general anesthesia was never required. In all patients, no pain nor discomfort was reported during the pre-operating infiltration and surgical procedure. We reported a major complication rate of 3.3% (4 hematomas and 6 seromas) and a minor complication rate of 6.0% (8 implant dislocation and 10 dystrophic scars formation).


TLA represents a safe and efficacious technique for performing breast augmentation surgery with sub-muscular implant positioning. This technique guarantees good pain control during and after surgery and has low incidence of postoperative side effects. Patients subjected to sub-muscular breast augmentation with TLA were satisfied.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Breast augmentation Sub-muscular Tumescent local anesthesia Breast implants 


Compliance with Ethical Standards

Conflicts of interest



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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  • Alberto Bolletta
    • 1
    Email author
  • Luca Andrea Dessy
    • 2
  • Luca Fiorot
    • 1
  • Alessio Tronci
    • 3
  • Antonio Rusciani
    • 2
  • Pedro Ciudad
    • 4
  • Emilio Trignano
    • 1
  1. 1.Department of Surgical, Microsurgical and Medical Sciences, Plastic Surgery UnitUniversity of SassariSassariItaly
  2. 2.Department of Plastic and Reconstructive Surgery“La Sapienza” University of RomeRomeItaly
  3. 3.Anesthesia and Intensive Care UnitUniversity of CagliariCagliariItaly
  4. 4.Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichungTaiwan

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