Background: Regional anesthetic techniques are becoming increasingly more common for a variety of surgeries. Current literature regarding regional anesthesia for breast surgery also involves sedation or general anesthesia (GA).Case: A 53 year old female underwent wide local excision breast surgery and sentinel node biopsy under combined thoracic paravertebral block and pectoralis nerve I and II block without concurrent sedation or GA. Conclusions This case report demonstrates patient acceptability for completely awake breast surgery with good surgical conditions. This technique could be used for high risk or motivated patients where a GA and its associated complications could be avoided.