AIMS: The aim of this study is to show the safety of a novel anesthetic and surgical technique called “cold tumescent anaesthesia”(CTA) in aesthetic breast surgery. CTA is a cold (4°C) dilute and tumescent anesthetic solution of lidocaine (0.1%) and epinephrine (0.1%) locally injected by the surgeon, volume depending on breast size and procedure.

METHODS: All patients undergoing aesthetic breast surgery under CTA and being operated by the first author from 2002 to 2022 were included. Inclusion criteria were: ASA score I or II. Exclusion criteria were: breast cancer or suspicious lump, contraindications to local anesthesia, cold agglutinin disease, coagulation or heart rhythm disorders, anxiety. Data on patients, surgery, complications, patient satisfaction and pain control were collected retrospectively from a prospectively maintained database.

RESULTS: A total of 4062 patients were operated in the study period, 2009(49.4%) underwent breast augmentation, 322(8.0%) mastopexy with implants, 1208(29.3%) mastopexy without implants, 523(13.3%) breast reductions. No major complications occurred. Wound or implant infections occurred in 81(2.1%) patients, wound dehiscences in 56(1.4%), postoperative bleeding requiring return to theatre in 4(0.1%) cases. 32(0.8%) patients developed capsular contracture, 40(1%) patients required reintervention due to implant rotation or rupture. All surgical procedures were performed under CTA plus light sedation. No cases were converted to general anesthesia. The mean operating time was 37±12 minutes for breast augmentation, 78±24 minutes for mastopexy with implants, 58±18 minutes for mastopexy without implants and 75±19 minutes for breast reduction. The median recovery time was 150(120-210) minutes and all patients were discharged within 3 hours after surgery. Median VAS score was 1.8 (IQR:1-3) at discharge. Patient satisfaction for the anesthetic technique was very high in 91.3%(n=1407) of cases.

CONCLUSIONS: CTA proved to be safe and feasible in selected patients and breast procedures in experienced hands. The learning curve is important to experience all benefits of CTA: reduced bleeding, reduced intra- and postoperative pain, easier surgical dissection, shorter operating time, faster recovery, low complication rate and high patient satisfaction.