Breast

Breast cancer is one of the most common cancers diagnosed in women1,2.  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 life3-5.  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 reconstruction8-11 and autologous breast reconstruction12-15.  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 surgery14,18.  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.

Expert Reviews

ERAS and the impact of sarcopenia on outcomes

ERAS and the impact of sarcopenia on outcomes Pędziwiatr M, Pisarska M, Major P, Grochowska A, Matłok M, Przęczek K, Stefura T, Budzyński A, Kłęk S. Laparoscopic colorectal cancer surgery…

Enhanced Recovery After Surgery: A Review 

Enhanced Recovery After Surgery: A Review  Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surgery. Epub January 11th 2017. Comments This review, written by three members…

Contacts

Professor of Surgical-Oncology

Claire Temple-Oberle (Canada)

Dr. Temple-Oberle is a University of Calgary Professor cross-appointed to the Departments of Oncology and Surgery, with a special interest in reconstructive plastic surgery. She completed her MD at…

Clinical Lecturer in the Department of Surgery at the University of Calgary

Alexandra Hatchell (Canada)

Dr. Alexandra Hatchell (MD, MSc, FRCSC) is an attending plastic surgeon at the Peter Lougheed Centre and Alberta Health Services and a Clinical Lecturer in the Department of Surgery…