The protocol is evidence-based, meaning the specific interventions are based on scientific findings found in published medical research and literature. The pathway of steps includes specific interventions that Dr. Tanna will use before (preoperatively), during (intraoperatively), and after surgery (postoperatively). These steps cover several aspects of patient care, such as patient education, pain management, nutrition, and mobility.

Patient Perioperative Pathway (P3): The ERAS Protocol for Breast Reconstruction

The Patient Perioperative Pathway (P3) is an innovative ERAS protocol, developed by Dr. Tanna and other expert colleagues, that is specific for patients undergoing breast reconstruction. This protocol has been shown to increase the quality of recovery, minimize postsurgical pain, and reduce the length of stay in the hospital.

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The steps in the ERAS protocol for breast reconstruction can be considered in three parts:

  • Before Surgery (Preoperative)
  • During Surgery (Intraoperative)
  • After Surgery (Postoperative)

The preoperative guidelines require that Dr. Tanna thoroughly review the operative procedure and risks of the surgery with you. For some patients, a preoperative lifestyle change may be recommended to minimize the risk of surgery, particularly for patients who smoke, have a high body mass index (BMI), or those with diabetes. Before the surgery, Dr. Tanna will also review the key components of postsurgical care, including a comprehensive overview of what to expect after surgery.  Finally, patients undergoing a flap-based reconstruction may require a special MRI scan to visualize the anatomy and blood vessels necessary for the surgery.

Immediately prior to and during the surgery, Dr. Tanna will also administer medications that will help combat postoperative nausea, vomiting, constipation, pain, and infection.  To specifically reduce postsurgical pain and eliminate use of narcotic pain medications, Dr. Tanna will perform various nerve blocks by injecting long-acting numbing medication.

After surgery, patients are closely monitored and provided opioid-free pain management. Once assessed for safety, the patient will be encouraged to eat and move within 24 hours of surgery to help promote enhanced recovery.

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Before Surgery

Patient education, shared decision making, and informed consent are performed prior to breast reconstruction. Included is a detailed discussion about:

  • Breast reconstruction options
  • Procedure details
  • Postsurgical hospital recovery with milestones and early discharge plan
  • Surgical risks
  • Postsurgical prescriptions
  • Postsurgical home instructions with drain care

During Surgery

Immediately Prior to Procedure (within 1 hour of surgery):

  • DVT prevention with subcutaneous heparin injection
  • Intravenous antibiotics


Exparel-based nerve blocks

  • Serratus plane 
  • Pectoralis muscle 
  • Intercostal muscle 
  • Drain site
  • Incisional site 
  • Transversus abdominus plane (TAP) Blocks

Pain Medication

  • Toradol (Ketorolac) – given within 1 hour of conclusion of the surgery
  • Tylenol (Acetaminophen) – given within 1 hour of conclusion of the surgery


  • Ondansetron or dexamethasone

After Surgery

After Surgery Instructions

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