BREAST RECONSTRUCTION SERVICES

Matching Expectations

Matching patient and surgeon expectation

Your recovery is one of the most important aspects of the reconstructive process. We use an enhanced recovery after surgery (ERAS) protocol to achieve an optimal recovery. Our goal in recovery is to reduce the need for narcotic pain medication, reduce in hospital stay, and return you to your normal activities and function as soon as possible.

• • • Enhanced Recovery After Surgery (ERAS) Goals
      • • Reduce hospital stay

          – We believe that your best recovery is in a place of comfort. For most, this place is at home with your support system. We strive to discharge you to go home as soon as medically safe once adequate pain control and post-operative monitoring is complete. In general with implant based reconstruction you will be able to be discharged the same or following day, with autologous reconstruction you will be able to be discharged in 2-3 days.

        • Reduce the need for narcotic pain medication
          • • Multimodal regimen:

              – We use a multimodal pain regimen to decrease the need for post-operative narcotic medication. Opioid pain medication has a harmful side effect profile and are addictive. We reduce their use by using multiple oral medications and nerve blocks in the peri-operative period. Pain pathways are complex and that is likely why a multimodal regimen works effectively, by effectively treating each pathway. We regularly also use nerve blocks. In the area of the breast, our protocol includes a combination of plane blocks (pectoral I and pectoral II) to provide local control of pain fibers. Surgeries involving the abdominal area, for example DIEP free flaps, local nerve fibers are blocked using a transverse abdominus plane (TAP) block. In majority of our procedures these blocks are preformed just prior to incisions by our anesthesia staff who use ultrasound guidance to improve efficacy.

              – Nerve Blocks

              • • • Pec I/II blocks with Exparel
                  • TAP blocks with Exparel
        • Return of function
          • • 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.