in Phoenix & Chandler, AZ
Improving your recovery and experience: 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 hospital stay, and return you to your normal activities and function as soon as possible.
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 postoperative monitoring are 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.
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 is 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 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. In surgeries involving the abdominal area, for example, DIEP free flaps, local nerve fibers are blocked using a transverse abdominus plane (TAP) block. In the majority of our procedures, these blocks are performed just prior to incisions by our anesthesia staff, who use ultrasound guidance to improve efficacy.
Our combined ERAS protocol allows for early pain-free ambulation postoperatively. This, in turn, speeds the overall recovery process. In addition to the ERAS protocol, we work closely with physical therapists. When time permits, pre-operative assessment (prehab) by a physical therapist assists 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 the upper body and core for the postoperative 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.