Anesthetising the older surgical patient present its own unique challenges. Heterogeneity is the most consistent feature of this age group and preoperative assessment and optimisation must take into account the varying comorbidities, extent of physiological ageing, frailty and the size of surgery which will determine patient outcome. Breast surgery can be undertaken either with local, regional or general anaesthesia and the choice of technique is individualised for each patient based on the risk benefit of each technique. Changes in pharmacokinetics and pharmacodynamics in this age group alters the drug responses of anaesthetic drugs and anatomical and neuronal changes influence the ability in performing regional blocks and the response to local anaesthesia. Anesthetic drugs which are short-acting, predictable and independent of organ metabolism are most suitable for this patient cohort and the use of ultrasound to aid placement of local anesthetic blocks has improved success rates and minimised complications.