Key recommendations support use of  opioid-sparing perioperative medications  , minimal preoperative fasting and early feeding , use of anesthetic techniques that decrease postoperative nausea and vomiting and pain , use of measures to prevent intraoperative hypothermia , and support of early mobilization after surgery .
Background : Enhanced recovery following surgery can be achieved through the introduction of evidence -based perioperative maneuvers .
This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery  and to provide evidence -based recommendations for an enhanced perioperative protocol .
Computed Tomographic Angiography in Planning Abdomen-Based Microsurgical Breast Reconstruction: A Comparison with Color Duplex Ultrasound
Background : To plan abdominal perforator-based microsurgical breast reconstruction , duplex ultrasound is often employed to preoperatively identify the location of abdominal wall perforating vessels . Recently , several groups have published the use of computed tomography angiography for preoperative planning in perforator flap breast reconstruction . The purpose of this study was to compare the accuracy of computed tomography angiography in locating clinical ly useful abdominal wall perforators with that of duplex ultrasound . Methods : A prospect i ve study was conducted of 22 consecutive patients undergoing 30 abdomen-based microsurgical breast reconstructions using both preoperative computed tomography angiography and duplex ultrasound .  Perforator data were obtained with both computed tomography angiography and ultrasound . The two largest perforators were chosen per abdominal side for comparison between studies . In addition , the locations of perforators were confirmed at surgery . Results : Computed tomography angiography preoperatively identified 83 of the largest perforators , while only 55 of these large perforators ( 66.3 percent ) were preoperatively identified on ultrasound . No superficial inferior epigastric arteries were identified by ultrasound . However , in all eight breast reconstructions performed with the superficial inferior epigastric system , the superficial inferior epigastric arteries were identified preoperatively as adequate size for microsurgical transfers , with an average diameter of 1.6 mm . Conclusions : There are many advantages to preoperative computed tomography angiography for planning abdominal perforator-based microsurgical breast reconstruction , including accurate identification of perforating vessels , the underlying branching pattern of the deep inferior epigastric artery , and the presence of the superficial inferior epigastric vessels . This study demonstrates the superiority of computed tomography angiography over duplex ultrasound as a tool for preoperative planning of perforator-based breast reconstruction
Key recommendations support use of  opioid-sparing perioperative medications  , minimal preoperative fasting and early feeding , use of anesthetic techniques that decrease postoperative nausea and vomiting and pain , use of measures to prevent intraoperative hypothermia , and support of early mobilization after surgery .
Background : Enhanced recovery following surgery can be achieved through the introduction of evidence -based perioperative maneuvers .
This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery  and to provide evidence -based recommendations for an enhanced perioperative protocol .