Summary Regional anaesthesia to facilitate awake mastectomy is increasingly recognised as a viable alternative for patients in whom general anaesthesia presents significant risk. This case report describes a successful total mastectomy in a patient with secondary angiosarcoma and multiple complex comorbidities. The planned regional anaesthetic technique included multilevel transverse paravertebral blocks, pecto‐intercostal fascial plane blocks and a supraclavicular brachial plexus block. The intricate sensory innervation of the breast, anterior chest wall and axilla present considerable challenges to achieving adequate anaesthesia; these are explored in detail, with emphasis on the necessity of an individualised approach which accounts for both patient‐specific and surgical factors. Sedation is commonly employed to enhance patient comfort during awake procedures; however, pharmacological selection and administration may be complicated in patients with pulmonary hypertension, as illustrated in this case. The patient experienced optimal conditions for surgical resection and reported a positive peri‐operative journey, from pre‐assessment to hospital discharge. A reflective account of the patient's experience is included. This case, in conjunction with existing literature, supports the broader implementation of awake mastectomy as a feasible and patient‐centred option in appropriately selected individuals.
Harling et al. (Thu,) studied this question.