Breast Reconstruction Recovery and ERAS Protocol
When I attend medical conferences, I take the opportunity to interview plastic surgeons about topics related to breast reconstruction. Breast reconstruction recovery and ERAS protocol is a topic I want readers to know about. Why? I feel it is an important part of a shared decision-making conversation with your plastic surgeon at the time of your consult. You simply ask, “Do you use the Enhanced Recovery after Surgery (ERAS) protocol in breast reconstruction?”
Dr. Minas Chrysopoulo from PRMA in San Antonio was the plastic reconstructive microsurgeon who performed my DIEP flap surgery. Although ERAS was not in place at the time of my breast reconstruction, I am excited to let others know PRMA and others are using this protocol now. The interview unfolds as we make comparisons between my recovery without ERAS and what Dr. C and his practicing partners now use to improve patient recovery after surgery. Let’s dig into the video conversation as we chat over coffee.
Challenging Aspects of my Recovery Without ERAS
- 5-day hospital stay.
- PCA: Patient controlled analgesia pump and the narcotics that made me sleepy and light-headed.
- Having no fluids after midnight the day before surgery.
- My catheter was not removed until about day 4 after my surgery.
- Multiple bags hanging off of my IV pole as I made laps around the hospital floor.
- Having IV fluids for four days in hospital made the catheter even more uncomfortable for me.
- Overconsumption of the lovely hospital broth. I wasn’t allowed to have solid food until I created “buffalo dust” …. Aka farted as the nurses used to say! They wanted to know my gut was waking up. The first plate of fruit after the “buffalo dust” event was like handing me a gourmet meal!
- Breathing treatments from respiratory therapy to clear the lungs of fluids. I really disliked the taste they left in my mouth. This is different that the breathing spirometer, which is still required.
Dr. C compassionately says, “Doesn’t sound like much fun.” He admitted he tried the broth and concurred it was a bit “nasty”. I went to visit some PRMA patients at day one and two after their surgery. One was being released at day two and the patients who had their surgery the day before I saw them were waiting for instructions to be release day two! I saw first hand the benefits of ERAS. We both agreed it’s been a game changer for patients recovering from microsurgical breast reconstruction. Here’s what Dr. C tells us:
- ERAS has been prescribed for many procedures, not just breast reconstruction.
- The protocol basically starts before surgery.
- It optimizes nutrition, pain control during and after surgery and speeds up the recovery process.
- ERAS avoids a lot of the narcotics surgeons used to be dependent on.
- Instead of having narcotics scheduled as a main method of pain control, these are only used if the other stuff you are taking for pain control is not working and you need a little bit of help.
- Patients experience less nausea and constipation.
The Specifics of ERAS Protocol
- A carbohydrate drink is given the night before surgery and again the morning of surgery. This prepares the body for surgery a lot better.
- The drink also helps the delayed onset of your GI system working after surgery. In other words, carbohydrate drink helps your system begin working a lot quicker.
- With ERAS the surgeon limits the amount of IV fluid given during the surgery. Visible, external swelling is not as present as well an any internal pressure on intestines speeding up the return of everything working after surgery.
- You no longer have to wait as long to return to a full diet.
- IV fluids are cut back quickly so the patient is getting only the fluid they need.
- No need for multiple bags hanging off of your IV pole as you walk around the hospital floor!
- Internal pain blocks are used at the time of surgery (intraoperatively) right over the nerves of the lower tummy reducing post-operative oral pain medication.
- The pain regiment now is Celebrex, a non-steroidal, Extra Strength Tylenol, and low dose Gabapentin. It is noted narcotics are available for possible break through pain.
- Dr. C points out it is the combination of these three drugs that has worked well for patients.
My favorite part of ERAS I observed first-hand, and Dr. C discusses, earlier mobilization and shorter length of hospital stay. The goal is to release patients at two days unless it is medically necessary to stay longer. Sure does beat the five day stay I had!
One of the members on the Journey Facebook page I admin did ask her surgeon if he was using ERAS protocol. He wasn’t but looked into, put it in place for her surgery, and she was happy to report her recovery was pleasantly easier and more successful than she imagined. Like Dr. C said,
“That’s patient advocacy for you right there. That’s the change right there!”