Medically reviewed by Mark D. Epstein, MD, FACS. Last updated: July 9th, 2026.
Next scheduled review: October 9th, 2026.
Yes, breast augmentation can be performed while you are awake, without general anesthesia, and the Preservé technique is what makes it practical. Because Preservé creates the implant space with gentle blunt dissection instead of cutting through tissue or muscle, the procedure is tolerable under local anesthesia with either no sedation or light sedation. No breathing tube, no IV general anesthetic, no grogginess, and you walk out of the operating room shortly after we finish.
As of July 1, 2026, I have performed 165 Preservé procedures, including 9 wide awake, at my QUAD A-accredited surgical facility in Hauppauge, New York. Here is exactly how it works and who it suits.
How does awake breast augmentation work?
For awake cases, we use either no sedation at all or light sedation to relax you, depending on your preference. Using a very tiny needle, I then numb the surgical area thoroughly with local anesthetic. Patients barely feel this. I give the numbing medication ten full minutes to do its magic. Next, a small incision in the skin is made. That is where the cutting ends! The Preservé instruments create the implant pocket with blunt dissection, which is the key: there is no sharp cutting of tissue deep in the breast, so the sensations are at most that of pressure, not pain. Most patients chat with us during the entire case. The entire procedure takes about 30 minutes.
What if I would rather not be aware of the surgery at all?
You have a middle option between fully awake and general anesthesia: intravenous twilight sedation, the same kind used during a colonoscopy, administered by a board-certified physician anesthesiologist. You breathe on your own, there is no breathing tube, and almost all patients have no memory of the procedure. And for patients who prefer general anesthesia, I offer that as well, but none of my patients have requested this for a Preservé augmentation alone. The surgical result is identical with all three options.
Why avoid general anesthesia?
- No airway instrumentation, no ventilator, and none of the rare but real risks that come with general anesthesia
- Post-anesthesia nausea, vomiting, and brain fog are very rare
- Faster discharge and a quicker return to feeling like yourself, often the same afternoon
- Many patients simply feel safer and calmer knowing they will be conscious and in control
- Patients who receive no sedation at all may even drive once they get home, although we still recommend having someone drive you home after surgery
To be clear, modern general anesthesia is very safe. Awake surgery is an option, not a requirement.
Will I feel pain during awake surgery?
You will feel touch and pressure but not sharp pain. The local anesthetic is placed methodically before anything else happens, and we test it before proceeding. If at any point you want more medication, we give it. In my awake cases to date, nine patients completed awake surgery with no issues; one required a little more sedation and was no longer awake for the surgery.
Who is a candidate for awake Preservé?
You need to be a Preservé candidate first: typically a first-time augmentation patient whose goals fit the 150 to 315 cc Ergonomix range, though many women with prior below-the-muscle implants are also candidates for my modified Preservé approach. Beyond that, the best awake candidates are calm about the idea of being conscious during surgery and are medically healthy. If the idea of being awake makes you anxious, twilight sedation or general anesthesia is the better experience, and the surgical result is identical either way.
What is recovery like after awake surgery?
Recovery from the surgery itself is the same rapid Preservé recovery: most patients resume normal daily activities the same day, and many go out to lunch or shopping within hours of surgery. What you skip is recovery from general anesthesia. My awake patients get dressed, walk out, and are typically eating a normal meal at home within hours. Patients who receive no sedation may drive the same day; everyone else may drive the day after surgery.
Frequently Asked Questions
Can breast augmentation really be done without general anesthesia?
Yes. The Preservé technique uses blunt dissection rather than cutting, which makes the procedure tolerable under local anesthesia with no sedation or light sedation. Patients are comfortable, awake, and able to go home shortly after surgery.
Is awake breast augmentation safe?
For appropriately selected healthy patients, it removes the risks associated with general anesthesia entirely. The procedure is performed in a QUAD A-accredited surgical facility with full monitoring throughout, with anesthesia services provided by a board-certified physician anesthesiologist when sedation is used.
Will I remember the surgery?
Patients who choose no sedation or light sedation typically remember the experience as relaxed and surprisingly uneventful. Patients who prefer to remember nothing can choose intravenous twilight sedation or general anesthesia instead.
Does awake surgery cost less?
Awake surgery still requires the presence of an anesthesiologist to monitor you. The costs are the same no matter the method of anesthesia required.
Disclosure: Dr. Epstein is a paid investigator in the Motiva U.S. FDA clinical trial and is compensated by Establishment Labs to train surgeons on the Preservé breast augmentation technique.
Sections - Preserve Breast Augmentation
- Preservé™ Breast Augmentation – A New Era!
- Why choose Dr Epstein for Preservé?
- Wide Awake Preservé
- Awake Preservé Breast Augmentation: No General Anesthesia
- Dr Epstein training other Preservé surgeons
- New innovation: Epstein Preservé Channel Dilator
- Preservé Breast Augmentation Cost (2026): What Determines the Price
- Is Preservé Breast Augmentation Worth It? Pros, Cons and Limits
Prev Chapter: Intro to Breast Augmentation »
Next Chapter: Motiva Implants – What You Need to Know »
Chapters – Breast Augmentation Guide
- Intro to Breast Augmentation
- Preservation Breast Augmentation – A New Era!
- Motiva Implants – What You Need to Know
- Five key decisions you need to make
- One-Day Recovery Breast Augmentation
- Anesthesia – General, Sedation or Local?
- Breast Lift (Mastopexy) with/without Implants or Fat
- What else should I know about breast augmentation?
- Important Things to Consider When You Decide to Move Forward With Breast Augmentation
- Revision of breast augmentation
- ALCL and Breast Implant Illness
