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BACKGROUND Tumescent local anesthesia (TLA) technique to obtain regional anesthesia and vasoconstriction of the skin and subcutaneous tissues is routinely adopted for several plastic surgery procedures. Here, we describe the use of TLA in primary subglandular breast augmentation. This series evaluates advantages and disadvantages of TLA in elective augmentation breast surgery as well as patients' response to this procedure. METHODS Between December 2008 and November 2011, 150 patients underwent bilateral primary subglandular breast augmentation under TLA and conscious sedation in the presence of a board-certified anesthesiologist. Midazolam 0.05 mg/kg IV and ranitidine 100 mg IV were given as premedication. Tumescent local anesthesia was composed of 25 mL of lidocaine 2%, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) in 1000 mL of 0.9% NS. The solution was delivered between the pectoral fascia and the mammary gland via a spinal needle. After infiltration, 45 minutes were allowed before surgery for local anesthetic effects to take place. RESULTS The mean age of the patients was 34.3 years. The average amount of tumescent solution infiltrated was 1150 mL, with a maximal dose of 17 mg/kg of lidocaine used. Operating time was 45 minutes and recovery room time averaged 125 minutes. Minor complications were found in a total of 9 (5.3%) patients, with no main surgery-related complications such as hematoma or seroma formation. CONCLUSIONS Breast augmentation under TLA and conscious sedation proved to be safe in the presence of a board-certified anesthesiologist and when performed with meticulous surgical technique.