Enhanced Recovery After Surgery (ERAS): Protocols in Post-Mastectomy Breast Reconstruction

The Safety of Same-day Discharge after Immediate Alloplastic Breast Reconstruction: A Systematic Review

“…With the incorporation of ERAS into plastic surgery over the last two decades, studies have demonstrated decreased opioid usage, as well as decreased hospital resources. 22 , 25 , 38 , 39 Dumestre et al 34 reported that enhanced recovery patients had decreased severe pain and nausea, while increasingly enjoying their food and feeling more rested. Similarly, Schwartz 36 reported that patient satisfaction was higher among immediate reconstructions with same-day discharge performed in an ambulatory surgery center.…”

“… 14 , 19 , 20 , 40 Mastectomy with breast reconstruction, when used in conjunction with ERAS, has also demonstrated decreased hospital resources by decreasing length of stay when compared with traditional recovery after surgery. 20 , 22 , 41 , 42 The guiding principles of ERAS include optimizing preoperative health, minimizing perioperative injury, and reducing the incidence and risk of postoperative complications. This study summarizes a plethora of data demonstrating among patients with similar preoperative risk factors, there is no increased risk of postoperative complications with same-day discharge after tissue expander and DTI breast reconstruction, with the added benefits to the patient including minimized hospital stay and thus decreased resource utilization.…”

The consideration for outpatient mastectomy during the COVID-19 global pandemic

“…Over the past two decades, successfully implemented Enhanced Recovery After Surgery (ERAS®) programs have shown that select mastectomy cases are able to be safely performed in the outpatient setting. 2 ERAS programs incorporate pre-operative counseling about post-operative expectations, opioid-sparing multimodal analgesia approaches, and early mobilization to optimize patient satisfaction while minimizing post-operative complications and the need for inpatient admission. 3 Evidence has demonstrated that outpatient mastectomies, with or without reconstruction, are safe with no increased risk of post-operative complications compared to inpatient mastectomies.…”

“…Studied populations for outpatient mastectomy are those who do not undergo reconstruction, those with direct to implant reconstruction, and patients who receive first phase reconstruction with expander placement. 2 , 3 , 4 Autologous tissue reconstruction can result in hospitalizations for several days; however, recent reports have shown that in select patients, 23-h observation can be a safe and feasible option. 5 Patient selection plays an important role when instituting the outpatient mastectomy as patients need to be educated on drain care, pain management, and when to call if complications or problems arise.…”

“…If a patient is unable to manage these issues without significant coaching or are limited in their abilities to care for themselves without significant support, the patient may not be the ideal candidate for this protocol. 2 , 3 , 4 …”