Optimizing perioperative outcomes in autologous breast reconstruction

Perioperative optimization in surgery is paramount to the success of an operation. This especially applies to autologous breast reconstruction where small details can make the difference between success and failure. In this article, the authors discuss a wide array of aspects of perioperative care in autologous reconstruction and best practices. Stratification of surgical candidates, including types of autologous breast reconstruction are discussed. The informed consent process, including benefits, alternatives, and risks specific to autologous breast reconstruction is delineated. The importance of operative efficiency and benefits of pre-operative imaging are discussed. The importance and benefits of patient education is examined. Also examined at length are pre-habilitation and its effects on patient recovery, antibiotic prophylaxis including duration and organism coverage, venous thromboembolism risk stratification and prophylaxis, anesthetic and analgesic interventions including multiple types of regional blocks are broken down. Flap monitoring methods and the importance of clinical exam are emphasized, and the potential risks of blood transfusion in free flap patients are examined. Post-operative interventions and determining readiness for discharge are also reviewed. The review of these components of perioperative care allows the reader to gain comprehensive insight into autologous breast reconstruction best practices and the important role perioperative care plays in this patient population.