INTRODUCTION: The importance of breast surgeries can be observed in the current context in which the increasingly growing number of restorative procedures and plastic surgeries in Brazil. To perform the various surgeries, several anesthesic techniques are used as general anesthesia, thoracic epidural or more recently, thoracic paravertebral block. Thus, it is essential to know about the safety of each anesthesic technique in these surgeries, which led to the realization of this review. OBJECTIVES: Analyze the benefits and complications of general anesthesia, thoracic epidural and paravertebral block in breast surgery. MATERIAL AND METHODS: We used the keywords “breast surgery general anesthesia”, “breast surgery thoracic epidural anesthesia” and “breast surgery thoracic paravertebral block” to draw up this systematic review of literature. The databases searched were PubMed, SciELO, MEDLINE, LILACS and Cochrane Library. The articles were selected using the following inclusion criteria: Medical journals from 1995 to 2011, in the languages English, Spanish and Portuguese, in order of relevance and study design of randomized controlled trials and cohort. The pre-selected articles were assessed individually by two reviewers and evaluated on their methodological quality by the Jadad scale, and were scored according to the criteria of randomization, blinding and accountability of all patients, including withdrawals. RESULTS: Fifteen articles were included in this review. The benefits of thoracic epidural anesthesia were better quality of postoperative analgesia, lower length hospitalization and the consumption of analgesics was also lower than general anesthesia. Hypotension and bradycardia were reported as possible complications. General anesthesia was more frequent reported with nausea, hypertension and vomiting. When associated with thoracic paravertebral block, promoted analgesia and anesthesia with lower complications than when applied as single anesthesic technique, as lower intensity of postoperative pain, less nausea and vomiting and less anesthesic recovery time. There are no studies that prove the effectiveness of paravertebral block when used without general anesthesia association. CONCLUSION: The epidural technique, despite its complications, remains the best option for regional block, and with general anesthesia, are the most commonly anesthesic techniques performed in breast surgeries, since evidence is lacking to prove the effectiveness of using thoracic paravertebral block in a patient who is not sedated. More research on the effectiveness of such techniques not associated with general anesthesia should be performed.