Before Surgery

Breast Surgery Preoperative Tests: A Checklist

UNE Plastic Surgery · Dr. Kim Uigeon, board-certified plastic surgeon · Published 2026-09-21 · Updated 2026-09-21

1. Why preoperative tests are needed

Tests before breast surgery are a step to prepare the surgery and anesthesia safely — not a formality. Current health, anemia, possible inflammation, bleeding risk, heart and lung status, medications, and allergies are checked and reflected in the surgical plan. Depending on the results, the surgical date, the anesthesia method, medication adjustments, and the need for further evaluation can change. So preoperative testing is best seen as confirming not only “whether surgery is possible” but “how to prepare it more safely.”

2. The tests done before surgery

Basic tests before breast surgery vary by clinic and by the individual. Usually they include blood tests, coagulation function, liver and kidney function, infection-related tests, an electrocardiogram (ECG), and a chest evaluation. Where needed, a pregnancy check or a breast ultrasound may be added. The same panel is not applied uniformly to every patient; the items needed change with age, past history, medications, the type of surgery, and the anesthesia plan. The American Society of Anesthesiologists’ preanesthesia standards likewise recommend that test items be decided by the patient’s condition.^[3]

When breast ultrasound or imaging is needed

Breast ultrasound or imaging can help confirm the existing breast condition, or when there is a lump, pain, discharge, or a past history of breast disease. Before implant surgery it also has value in recording the preoperative state to set a baseline for later monitoring. Depending on age and personal history, a mammogram or additional imaging may be needed. If you have a recent breast-screening result, bring it to consultation. It is not a test every patient needs uniformly; the medical team decides by history, symptoms, and age together.

3. Anesthesia and what to disclose beforehand

General anesthesia is the standard for breast augmentation, for two reasons. Techniques that dissect the pectoralis, such as dual plane, need a muscle relaxant to release the muscle enough for accurate dissection, and a muscle relaxant can only be used under general anesthesia. And with the airway secured, breathing stays stable throughout surgery. Sedation (twilight) delivers a sedative intravenously to keep you deeply asleep while breathing on your own; it recovers quickly with less nausea, but a muscle relaxant cannot be used, so it is limited for wide dissection, and deep sedation can suppress breathing and needs closer monitoring. It is an option chosen for smaller dissection after a specialist anesthesiologist’s assessment.

More important than the method is whether someone dedicated to anesthesia is present throughout. During surgery, ECG, oxygen saturation, end-tidal CO₂, blood pressure, body temperature, and anesthetic depth are watched and adjusted in real time. In consultation, confirm whether dedicated anesthesia staff are on site and whether the anesthesia fee is listed separately in the estimate.

Six things to disclose at the pre-anesthesia assessment

Anesthesia safety starts at the pre-assessment. Report the following accurately — do not hide them, as the anesthesia plan and drug choice depend on them.

• Drug allergies and past anesthesia reactions: reactions to antibiotics, analgesics, or anesthetics; severe nausea or difficulty waking after previous anesthesia.
• Chronic conditions: hypertension, diabetes, thyroid disease, asthma, heart or liver disease, sleep apnea.
• Current medications: everything — anticoagulants, hormones, herbal medicine, supplements.
• Smoking and drinking habits: they affect anesthesia and wound healing.
• Possible pregnancy and menstrual cycle: relevant to anesthetic drug choice and safety.
• Family history: if any relative had a rare reaction such as high fever during anesthesia, be sure to say so.

4. Checking medications and supplements

The thing most often missed is supplements — people mention their medications but not their supplements. Before surgery, tell the medical team every medication and supplement you take. Blood-pressure and diabetes drugs, anticoagulants, oral contraceptives, hormones, anti-inflammatory painkillers, aspirin, and omega-3 may need adjustment before surgery, and so do some herbal remedies and health supplements. Stopping a drug on your own can be dangerous, so whether and when to stop must follow the medical team’s guidance. ASPS likewise advises avoiding bleeding-risk drugs such as aspirin and anti-inflammatories when preparing for augmentation.^[1]

Why smoking is stopped for 8 weeks around surgery

Nicotine constricts blood vessels. A surgical site needs enough blood flow to heal, and nicotine blocks it — increasing delayed wound healing, infection, and hypertrophic scarring, and, in surgery around the nipple such as a lift, even the risk of skin necrosis. It also links to capsular contracture: in a study of 212 primary augmentation patients, smoking was an independent risk factor, at about 3× the risk (Li & Xiao, Frontiers in Surgery, 2025; odds ratio 2.95).^[4] The standard is from 4 weeks before surgery to 4 weeks after. Four weeks before, because that is how long nicotine’s effect takes to clear the body; four weeks after, because it is the core healing window. With a concurrent lift, 8–12 weeks is advised. E-cigarettes count the same if they contain nicotine, and nicotine patches are also avoided around surgery. Even occasional smoking constricts vessels with a single puff, so it must stop completely. If quitting is hard, say so honestly — planning around a known habit is safer than operating without knowing. Even after surgery, wait at least 4 weeks, preferably 8, before smoking again.

Alcohol affects bleeding, swelling, drug metabolism, and recovery. The standard is to avoid it for 1 week before and 1 month after surgery.

5. What to confirm before implant surgery

Before implant surgery, understand the implant type, size, profile, placement, and incision well. The expected recovery, long-term care, chance of revision, and possible complications are covered too. The FDA also treats a patient decision checklist as important, so that patients understand the risks and benefits before implant surgery.^[2] Implants are not lifetime devices; over time, rupture, capsular contracture, position change, and the possibility of revision can arise. So before surgery it is best to be told not only the short-term shape but the long-term care.

6. Day-before and day-of preparation

Preparation the day before is simple — it looks like a lot but is only a few things. The day before, confirm the fasting time, whether to take your medications, the arrival time, whether a guardian will accompany you, how you will get home, and comfortable clothing. On the day, prepare easy on-off clothing such as a front-opening top, and remove jewelry, contact lenses, nail polish, and makeup as the clinic directs. Since driving yourself after surgery is difficult, arrange your way home in advance. If there is a support bra or compression garment to wear after surgery, prepare it as directed.

Why fasting is required and how to keep it

Preoperative fasting reduces the risk of stomach contents refluxing or entering the airway during anesthesia. The fasting time varies with the anesthesia method and the clinic’s guidelines, so keep exactly to the time you were given. Water, coffee, gum, candy, and milk-containing drinks may also be restricted per the clinic’s guidance. Eating or drinking on your own on the day can change the surgical schedule.

Pre-op checklist

• Have you told the medical team every medication and supplement you take?
• Have you confirmed the smoking and alcohol adjustment periods?
• Have you checked components that affect bleeding — aspirin, anti-inflammatories, omega-3?
• Have you shared past surgeries, anesthesia experiences, and allergies?
• Have you prepared any recent breast-screening result?
• Have you confirmed the exact preoperative fasting time?
• Have you arranged a guardian and your way home for the day?
• Have you prepared a front-opening top and comfortable clothing?

7. When the surgery date should be adjusted

When rescheduling is suggested, some feel let down — but most reasons for postponing resolve in a few days, and those few days change the whole recovery. A cold, fever, dermatitis, inflammation at the surgical area, or an abnormal test result can lead to rescheduling. So can uncontrolled blood pressure or blood sugar, a medication issue, a broken fast, or possible pregnancy. If your condition is off before surgery or a new symptom appears, tell the clinic rather than hiding it. Adjusting safely can matter more than pushing ahead.

8. Summary

• Test items depend on the patient and the surgical plan. Blood test, coagulation, ECG, and chest evaluation are basic; breast ultrasound and imaging are decided by history, symptoms, and age.
• General anesthesia is standard, and dedicated anesthesia staff on site matter more than the method. Disclose six things without hiding: allergies, chronic conditions, medications, smoking, possible pregnancy, and family history.
• Stop smoking 4 weeks before and 4 after; avoid alcohol 1 week before and 1 month after. Nicotine works against healing, infection, scarring, and contracture, and e-cigarettes and patches count the same. Do not stop medications on your own; adjust per guidance.
• If your condition is off or a test is abnormal, the date can be adjusted. Adjusting safely can help both recovery and result more than pushing ahead.

References

1. American Society of Plastic Surgeons. Breast Augmentation Preparation. plasticsurgery.org (Avoid aspirin and anti-inflammatory bleeding-risk drugs.)
2. U.S. Food and Drug Administration. Breast Implant Surgery. fda.gov (Patient decision checklist before implant surgery.)
3. American Society of Anesthesiologists. Basic Standards for Preanesthesia Care. asahq.org (Test items decided by patient condition.)
4. Li XY, Xiao SQ. Analysis of risk factors for capsular contracture after breast augmentation: a retrospective study. Front Surg. 2025;12:1596993. doi:10.3389/fsurg.2025.1596993. (212 patients, 386 implants; smoking odds ratio 2.95.)