Performing aesthetic breast surgery requires the surgeon’s skill, creativity, knowledge, mental focus, and a properly controlled operating room environment. Given the complexity and demands of the procedure, the surgeon should not be responsible for administering sedation or monitoring the patient’s vital signs during the operation. It is unsafe for the surgeon to manage intraoperative factors such as fluctuations in blood pressure, heart rate, or respiratory irregularities. Therefore, an anesthesiologist should be present and in charge of anesthesia throughout the entire procedure. The choice of anesthesia—whether general anesthesia, local anesthesia combined with intravenous sedation, or epidural anesthesia with sedation—should be based on a mutual understanding between the surgeon and the anesthesiologist. While some issues may be considered minor in other surgical specialties, they hold significant importance in aesthetic breast surgery, as patients are often particularly concerned about the surgical outcome, intraoperative comfort, and postoperative pain.