Our combined ERAS protocol allows for early pain free ambulation post operatively. This in turn speeds the overall recovery process. In addition to the ERAS protocol we work closely with physical therapist. When time permits, pre-operative assessment (prehab) by physical therapist assist in upper extremity use, posture and core strengthening. Patients who are admitted may see an inpatient therapist during their hospitalization. We also have guidelines for therapy of upper body and core for the post-operative period. In our experience functional outcomes improve with preemptive therapy, to return function prior to the onset of any deficit. In other words, it is better to prevent than treat a functional deficit. Upper body and posture therapy are important for all patients undergoing breast reconstruction. When autologous reconstruction is performed using abdominal tissue, core strengthening at the appropriate time is also a focus.