Awake Combined Breast Procedures (Mix and Match) in Ottawa

Combined Breast Procedures (Mix and Match) at a glance

Typical operating time	About 2 to 4 hours, depending on the combination
Awake suitability	Selected patients only
Typical return to desk work	Desk work often within 1 to 2 weeks
Anesthesia	Local anesthesia with or without sedation. General anesthesia arranged if needed
Setting	Outpatient, with an anesthesiologist present throughout

Times are typical ranges for planning, not promises. Your plan is individualized.

What is combined breast procedures (mix and match)?

Common combinations include implant removal with a lift, implant removal with fat transfer, augmentation with a lift, fat transfer with a lift, and implant exchange. Which combination is right, and whether to do it in one operation or in stages, depends on your anatomy, goals and safety.

Who may be a good candidate

• People who want implants removed and breast shape restored
• Those with both volume loss and drooping
• Patients who prefer a single recovery when it is safe to do so
• Patients who are open to staging if that is the safer path

Why awake combined breast procedures (mix and match) may work

Published series report augmentation with lift under tumescent local anesthesia, augmentation and lift under local anesthesia with sedation, and implant removal with simultaneous lift. For well-selected patients, combinations of moderate length can be done awake. Our aim is to keep you as comfortable as possible while an anesthesiologist monitors you throughout.

When awake may not be the right choice

The more steps combined, the longer and more complex the operation. If a combined awake plan is too long or too demanding, we will recommend staging or general anesthesia. Safety decides, not preference alone.

Your awake combined breast procedures (mix and match) journey

1. Before surgery (pre-op)

We map out which steps are needed, whether to stage them, and what each recovery will look like.

• A consultation to review your goals, health history, medications and previous surgeries, and a physical examination
• An anesthesia assessment to decide whether an awake plan is appropriate and safe for you
• Photographs, with your consent, and a written plan, quote and consent form
• Medication guidance, including when to stop blood thinners, certain supplements, and smoking or vaping
• Fasting instructions from the anesthesia team. Follow them exactly
• A ride home and an adult to stay with you after surgery

2. Day of surgery (intra-op)

Local anesthetic is infiltrated and sedation is adjusted as the operation moves between steps. The anesthesiologist monitors you continuously and can deepen the anesthetic if required.

• You arrive, change, and meet the surgeon and anesthesiologist, and your markings and plan are confirmed
• An IV and monitors are placed. The anesthesiologist stays with you from start to finish
• Local anesthetic is given. Expect brief stinging, then numbness, and light sedation if planned
• You can listen to music, talk with the team, and tell us at any time if you feel discomfort
• Afterward you rest in recovery, receive written instructions and go home with your driver

3. Recovery (post-op)

You are observed in recovery, given written instructions and pain-control guidance, and scheduled for follow-up. Call us or seek urgent care for fever, spreading redness, severe or worsening pain, heavy bleeding, chest pain, shortness of breath, or leg pain or swelling.

When	What is typical
Days 1 to 3	Soreness and tightness. Supportive bra and any dressings in place.
Week 1 to 2	Many return to desk work within 1 to 2 weeks, depending on the combination.
Weeks 2 to 6	Activity is resumed in stages as directed.
3 to 12 months	Shape settles and scars mature.

Timelines are general and vary. Your surgeon gives you instructions specific to you.

Anesthesia options

Anesthesia options range from local anesthesia, with or without sedation, to general anesthesia. An anesthesiologist is present throughout your procedure and recommends an approach after reviewing your health, the extent of surgery and your preferences. If an awake approach is not suitable, general anesthesia is arranged. Plans can change during surgery if comfort or safety requires it, including deepening sedation or converting to general anesthesia.

Learn more: anesthesia options, levels of anesthesia, fear of intubation, and pain perception and music.

Alternatives

Doing the steps in separate operations, doing one step only, or no surgery.

Risks

Risks of each component apply and can add together, including wound-healing problems, asymmetry, scarring, nipple sensation changes, bleeding, infection, fat necrosis if fat transfer is used, a need for revision, and anesthesia-related risks.

Anesthetic risks include reactions to medications, breathing or airway events, the need to deepen sedation or convert to general anesthesia, and, rarely, transfer for further care. All surgery carries risk, and results are not guaranteed.

Frequently asked questions about awake combined breast procedures (mix and match)

Can I combine implant removal and a lift?

Often yes. Published work describes explantation with simultaneous mastopexy. We assess your skin and tissue.

Is one operation safer than several?

Not necessarily. Staging can reduce risk for some patients.

Can a combination be done awake?

Moderate combinations in selected patients can be. Longer ones may be better with general anesthesia.

How do I choose?

Book a consultation. We examine you and explain which steps make sense.

Related procedures

• Awake Breast Implant Removal (Explant)
• Awake Breast Augmentation with Lift (Augmentation-Mastopexy)
• Awake Breast Fat Transfer

Pricing for this procedure is quoted at your consultation. See pricing and financing.

Explore your options at a consultation

References

1. Messa CA, et al. Breast explantation with simultaneous mastopexy and volume restoration: an analysis of clinical outcomes and prospective quality of life. Aesthet Surg J. 2023;43(8):840-852. PMID 36911998
2. Ziani F, Tettamanzi M, Arrica G, et al. Safe and effective augmentation mastopexy with tumescent local anesthesia: a decade of experience. J Clin Med. 2024;13(20):6057. PMID 39458008
3. Colque A, Eisemann ML. Breast augmentation and augmentation-mastopexy with local anesthesia and intravenous sedation. Aesthet Surg J. 2012;32(3):303-307. PMID 22290411
4. Haws M, Lawrence M. Explantation: techniques and outcomes. Clin Plast Surg. 2026;53(2):329-339. PMID 41826053