Darent Valley Hospital’s Empress Unit recently reached a remarkable milestone in successfully performing the Trust’s first awake mastectomy on a 92-year-old patient who remained conscious and conversational throughout the procedure. The surgery, a left mastectomy, performed by Dr. Islam Saleh Abdo (Consultant in Anaesthetics and Intensive Care) and Mr. David Westbroek (Oncoplastic Breast Consultant), was carried out using a paravertebral regional block - a technique that provides effective pain relief without the need for general anaesthesia.
Due to the patient’s age and multiple co-morbidities, general anaesthesia (GA) posed significant risks. However, thanks to the innovation and skill of the surgical and anaesthetic teams, our patient, Sylvia, was able to undergo life-saving breast cancer surgery safely and comfortably while awake.
This pioneering approach is especially beneficial for frail, elderly, or high-risk patients who would otherwise be deemed unsuitable for surgery due to the dangers associated with GA. By avoiding general anaesthesia, patients are less likely to experience post-operative complications such as confusion, delirium, respiratory issues, and cardiac events—all of which are more common in older populations.
In addition to safety, the use of regional anaesthesia allows for same-day discharge and a quicker overall recovery. Importantly, it also empowers patients with more options. For carefully selected cases, awake surgery provides a real alternative, giving patients greater choice and autonomy in their treatment journey.
We were grateful to hear all about the experience first-hand from 92-year old Sylvia, who reflected “The preparation for the whole experience was so good and supportive it [the procedure] did not worry me at all, none of it worried me. I thought it was very well set up.
My personal experience was that it was much nicer to recover at home but you do need to make preparations before you come in, which I did. It’s much better to be at home.”
Sylvia’s advice to other patients undergoing the same procedure would be, “Don’t worry about it! I can assure you, I had personally had no worries about it at all! The support I received at Darent Valley was really exceptional. I’ve got no criticism of anything”
Dr. Islam Saleh Abdo said “We’re incredibly proud to have performed the first awake mastectomy in our hospital—one of only a handful of cases done this way across the UK. The procedure was carried out under a multilevel paravertebral block on a 92-year-old patient who had declined general anaesthesia due to frailty. Thanks to a carefully tailored anaesthetic plan and outstanding collaboration between the surgical and anaesthetic teams, the operation was a complete success.
Awake breast surgery remains uncommon and is often considered a niche technique, but it holds significant potential—especially for elderly or polymorbid patients who may be deemed too high risk for general anaesthesia. Our patient remained comfortable and fully awake throughout the procedure, and required no post-operative opioids—clearly demonstrating how effective regional anaesthesia can be when performed with precision and care.
This case marks a true breakthrough for our hospital. It highlights what’s possible when innovation is driven by safety, compassion, and patient-centred care. It also underscores the importance of close, real-time collaboration between anaesthetist and surgeon. We hope this sets a precedent and encourages more clinicians to explore awake techniques—ultimately expanding access to life-saving surgery for our most vulnerable patients.”
The Trust extends thanks to our dedicated colleagues, Dr. Abdo and Mr. Westbroek, for their care, innovation and expertise – all of which made this first awake mastectomy at DGT possible. We also send our very best wishes to Sylvia for a smooth and speedy recovery.