Can I be awake for breast implant removal?

September 29, 2025 •

4 min read

According to the American Society of Plastic Surgeons, breast implant removal can be a viable option for many patients who wish to reverse their initial augmentation. So, can I be awake for breast implant removal? The answer is often yes, depending on several key factors related to the procedure's complexity and the patient's individual health and comfort level.

Quick Summary

Yes, it is possible to undergo a breast implant removal procedure while awake using local anesthesia and/or conscious sedation, but this is only suitable for specific cases. The complexity of the surgery, including whether a full capsulectomy is required, heavily influences the necessary level of anesthesia.

Key Points

Awake Surgery is Possible: For simple explant procedures without complications like implant rupture or severe capsular contracture, you can remain awake using local anesthesia and/or conscious sedation.
Anesthesia Type Depends on Complexity: If a full capsulectomy (removal of the implant and scar tissue capsule) or a combination with other procedures like a breast lift is needed, general anesthesia is typically required.
Benefits of Being Awake: Opting for local anesthesia offers a faster recovery with less postoperative grogginess, nausea, and pain compared to general anesthesia.
Patient Anxiety Matters: Personal comfort and anxiety levels play a role in determining the best anesthesia approach. Conscious sedation can help anxious patients relax while remaining awake.
Consult a Board-Certified Surgeon: An experienced, board-certified plastic surgeon will evaluate your specific situation to recommend the safest and most suitable anesthesia option for your breast implant removal.

Understanding Anesthesia Options for Explant Surgery

When considering explant surgery, patients have a few different anesthesia options. The right choice depends on the individual's health, the complexity of the procedure, and their personal comfort with being awake during surgery. It's crucial to have a detailed discussion with a board-certified plastic surgeon to determine the most appropriate and safest approach for your specific situation.

Local Anesthesia and Conscious Sedation

For many simple breast implant removal cases, a patient can remain awake throughout the procedure. This approach, often called 'wide awake' or 'conscious sedation' surgery, involves using local anesthesia to numb the breast area completely while the patient remains relaxed and aware. The benefits of this method include a quicker recovery, reduced costs, and the avoidance of general anesthesia risks.

Local Anesthesia: The surgeon injects a numbing agent, such as lidocaine, directly into the breast tissue. This ensures the patient feels no pain during the procedure, though they may feel some pressure. This technique is often used for straightforward removals where there are no complications like a ruptured implant or severe capsular contracture.
Conscious Sedation: In addition to local anesthesia, IV sedation can be administered to help the patient feel calm and relaxed, often causing them to forget most of the procedure. This is an excellent option for patients who prefer not to be fully conscious but want to avoid general anesthesia.

General Anesthesia

General anesthesia is the standard approach for more complex explant surgeries. This involves the patient being completely unconscious during the procedure. It is necessary in cases where the surgery is more extensive or complicated.

Capsulectomy: If the scar tissue capsule around the implant is thickened, calcified, or ruptured, a capsulectomy (removal of the entire capsule) is necessary. This is a more involved procedure and requires general anesthesia to ensure patient safety and comfort.
Combined Procedures: If the explant surgery is combined with other procedures, such as a breast lift (mastopexy), general anesthesia is typically required.

Factors Determining the Best Anesthesia Method

The decision between being awake with local anesthesia and being asleep with general anesthesia is not one-size-fits-all. A surgeon will evaluate several factors to make a recommendation.

Surgical Complexity: Simple explant-only procedures on smooth, intact implants are often candidates for local anesthesia. Complicated cases involving capsulectomy or implant rupture require general anesthesia.
Patient Anxiety: Some individuals may feel highly anxious about being awake during surgery, even with sedation. For these patients, general anesthesia can be a better choice for a more comfortable experience.
Presence of Additional Procedures: Combining explant surgery with a lift or fat transfer necessitates general anesthesia due to the increased invasiveness.
Overall Health: For patients with certain health conditions, avoiding general anesthesia and its associated risks may be preferable if the procedure is suitable for a local approach.

A Closer Look at the Procedure: What to Expect

Regardless of the anesthesia type, the surgical steps are generally consistent. The surgeon will make an incision, often reusing the original one to minimize new scarring, and then proceed with the removal.

During Awake Explant Surgery

The surgeon will administer local anesthetic injections to thoroughly numb the breast tissue.
You will be given an oral or IV sedative to help you feel relaxed and at ease.
You will be fully conscious but will not feel any pain, only pressure or tugging sensations.
The surgeon will remove the implant and close the incision, after which you can go home after a short monitoring period.

The Recovery Difference

Local Anesthesia Recovery: Quicker and smoother. You will avoid the common post-op side effects of general anesthesia like grogginess, nausea, and disorientation. This can lead to a faster return to daily activities.
General Anesthesia Recovery: May include grogginess and nausea, and require a longer recovery period. A more extensive capsulectomy can also lead to more discomfort and longer healing.

Choosing a Qualified Surgeon

The most important step in deciding your anesthesia options is selecting a board-certified plastic surgeon with significant experience in explant surgery. They will conduct a thorough consultation to discuss your medical history, goals, and the complexity of your procedure. This consultation is critical for an honest and safe assessment of whether an awake explant is a suitable option for you. The surgeon's expertise and the specific surgical facility are paramount to ensuring a positive outcome.

Anesthesia Options Comparison


Feature	Local Anesthesia (Awake)	General Anesthesia	Conscious Sedation
Patient State	Awake and aware, feels no pain	Completely unconscious	Relaxed, possibly drowsy, minimal memory
Suitability	Simple explant, no rupture/contracture	Complex capsulectomy, combined procedures	Simple explant, anxious patients
Side Effects	Minimal; potential anxiety	Nausea, grogginess, sore throat	Minimal; temporary grogginess
Recovery	Faster; no anesthetic lingering effects	Slower; requires more time to recover from sedation	Faster than general; less groggy than general
Risks	Lower risk compared to general anesthesia	Higher risk, especially for those with medical conditions	Lower risk than general anesthesia
Cost	Generally less expensive due to less facility time and fewer staff	Typically more expensive due to extended facility and anesthesia provider costs	Often less expensive than general anesthesia

Conclusion: Making the Right Choice for Your Health

Deciding whether you can be awake for your breast implant removal depends heavily on the specifics of your case. For simple explants without complications, awake surgery using local anesthesia, potentially supplemented with conscious sedation, is a safe and increasingly popular option. It offers benefits like faster recovery and reduced risks associated with general anesthesia. However, for more complex procedures, general anesthesia remains the safer choice. A comprehensive consultation with an experienced, board-certified plastic surgeon is essential to ensure that the chosen anesthesia method prioritizes your safety, comfort, and best possible outcome. For further information and patient resources on explant surgery, consult the American Society of Plastic Surgeons website.

Frequently Asked Questions

No, you should not feel any pain during the procedure. The surgeon will use a local anesthetic to thoroughly numb the breast area. While you may feel some pressure or movement, you will not experience any sharp pain. For patients who are still anxious, conscious sedation can be used to promote relaxation.

Local anesthesia involves numbing only the specific surgical area, allowing you to remain fully conscious. Conscious sedation, or IV sedation, uses medication to induce a state of deep relaxation, where you are still responsive but typically have little to no memory of the procedure. For explant surgery, they are often used together.

General anesthesia is required for more extensive procedures. This includes situations where a full capsulectomy (removal of the scar tissue capsule) is necessary due to rupture, severe contracture, or other complications. It is also required if the explant is combined with other surgeries, such as a breast lift.

Recovery is generally quicker for explants performed with local anesthesia compared to general anesthesia. Most patients can resume normal activities within a few days, though strenuous exercise should be avoided for a few weeks. You will avoid the lingering grogginess and nausea often associated with general anesthesia.

Your candidacy depends on the complexity of your explant surgery and your personal health. Simple removal of an intact implant is often suitable for awake surgery. If you have a ruptured implant, significant capsular contracture, or plan to have a breast lift, general anesthesia will likely be recommended. A consultation with a board-certified surgeon is the best way to determine your eligibility.

The risks associated with local anesthesia are generally lower than with general anesthesia. The main consideration is patient comfort and anxiety. If a patient is too anxious, conscious sedation can help. There is always a small risk of infection or bleeding, but these are risks with any surgical procedure.

Yes, explant surgery performed with local anesthesia and/or conscious sedation is often more cost-effective than general anesthesia. This is because it can be done in an in-office surgical suite, reducing facility costs and the need for an anesthesiologist and their monitoring equipment.