# Enhanced recovery after breast reconstruction (ERAS pathway for implant and flap reconstruction)

Source: https://onco.cc/protocols/enhanced-recovery-after-breast-reconstruction/  
OnCo record `enhanced-recovery-after-breast-reconstruction` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Enhanced recovery for breast reconstruction means good information beforehand, stopping smoking for a month, a short fast with a sugary drink two hours before, anti-sickness and pain medicines that spare opioids, keeping warm, eating within a day and getting up within a day, with close checks on a flap in the first three days.

## Summary

The ERAS Society consensus review (2017; 18 items, GRADE) is the only specialty guideline found for breast reconstruction. Every recommendation is graded strong; evidence is high for opioid-sparing multimodal postoperative analgesia and conventional sutures, and moderate or low (often extrapolated from other surgery) for the rest: detailed counselling; one month without smoking or heavy alcohol and weight reduction to a BMI of 30 or less (high evidence for obesity); CT angiography if perforators need mapping; clear fluids to 2 hours and a maltodextrin drink 2 hours before (low evidence); VTE risk assessment and LMWH or heparin with mechanical methods for those at higher risk; chlorhexidine and IV antibiotics within 1 hour of incision; multimodal antiemetics; total intravenous anaesthesia; active warming above 36°C; avoiding over- and under-filling with balanced crystalloid, goal-directed therapy and vasopressors where needed; food within 24 hours; mobilisation within 24 hours; frequent flap monitoring in the first 72 hours; and physiotherapy and support after discharge. NICE NG180 offers an enhanced recovery programme for elective major surgery.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: ERAS breast reconstruction; enhanced recovery DIEP flap; fast-track breast reconstruction; perioperative care for breast reconstruction

## Connected records

- protocols: [Blood clot prevention around cancer surgery, including extended prophylaxis after major abdominal and pelvic operations](https://onco.cc/protocols/vte-prophylaxis-after-cancer-surgery/), [Routine tests before planned surgery, by size of operation and fitness](https://onco.cc/protocols/routine-preoperative-tests/), [Surgical site infection prevention: skin preparation, antibiotic timing, warming and wound care](https://onco.cc/protocols/surgical-site-infection-prevention/)
- cancers: [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- technologies: [Enhanced recovery (ERAS) and perioperative nutrition](https://onco.cc/technologies/eras-perioperative-nutrition/)
- terms: [Breast reconstruction](https://onco.cc/terms/breast-reconstruction/), [Mastectomy](https://onco.cc/terms/mastectomy/)
- ideas: [Clear drinks until two hours before an operation, rather than nothing from midnight](https://onco.cc/ideas/idea-pu-shorter-fasting-before-surgery/), [Enhanced recovery after cancer surgery, with each element's compliance measured and fed back](https://onco.cc/ideas/idea-pu-enhanced-recovery-with-measured-compliance/)

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