**8.2 Anesthesia**

General anesthesia is required when performing this procedure given the amount of muscle manipulation. However, tumescent local anesthesia can facilitate easier dissection and resection while minimizing the depth of general anesthesia required. This will decrease postoperative pain requirements and risk of nausea and vomiting, both of which can complicate the early postoperative period. A modified Klein solution (0.5% lidocaine with 1:500,000 epinephrine) is injected into the planned incisions, subpectorally and most importantly into the dermis in the areas of planned de-epithelialization. This is typically done preoperatively in the OR with the patient asleep after a quick prep with alcohol or 4% chlorhexidine. Once administered the patient is reprepped and draped in standard fashion.
