Breast

Breast cancer is one of the most common cancers diagnosed in women^1,2.  Breast reconstruction has been identified as a gold standard for women undergoing breast cancer treatment as it has demonstrated improvements in satisfaction and quality of life^3-5.  Given the ongoing stress to the global health care systems, two main goals of health care include providing the best quality of patient care while optimizing health care costs and expenditures.  Therefore, Enhanced Recovery After Surgery (ERAS) protocols have received growing attention due to providing improvement in patient outcomes while documenting health care savings.  Although ERAS protocols gained initial popularity in alternate surgical specialties, these protocols are gaining recognition and acceptance in breast surgery and specifically breast reconstruction surgery.

The first landmark ERAS study with breast reconstruction patients focused on autologous, or microvascular and free flap, breast reconstruction⁶.  This study demonstrated significantly decreased opioid consumption and length of hospital stay without any differences in complications versus traditional postoperative pathways.  In 2017, the ERAS Society published its consensus recommendations for an ERAS protocol specific to breast reconstruction surgery⁷.  The published ERAS protocol consists of 18 key recommendations, of which the key tenets include: multimodal analgesia and reduction of opioid consumption, use of anesthesia to decrease postoperative nausea and vomiting and pain, minimal preoperative fasting and early feeding, and early postoperative mobilization⁷.

Since the publication and dissemination of the ERAS guidelines for breast reconstruction, multiple studies have shown significant reductions in opioid consumption and length of hospital stay for both implant-based breast reconstruction^8-11 and autologous breast reconstruction^12-15.  The combination of these key findings have led to improvements in the patient experience and significant health care savings¹⁶.

Although the consensus recommendations for an ERAS protocol specific to breast reconstruction⁷ and associated postoperative order sets for these ERAS pathways¹⁷ have been available since 2017, there is still incomplete implementation of ERAS protocols for breast reconstruction surgery^14,18.  Therefore, our goal is to continue to advocate for adoption of ERAS protocols amongst surgeons performing breast reconstruction while providing the necessary tools and education to make the adoption of ERAS protocols feasible for surgeons.