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 .
Evaluation of a New Skin Closure Device in Surgical Incisions Associated With Breast Procedures
Background A novel topical skin adhesive system was developed to close the outermost layer of skin in an expeditious manner . To determine its clinical utility in breast procedures , a prospect i ve clinical investigation was undertaken to demonstrate equivalence of a new adhesive ( PRINEO ™ Skin Closure System ) to intradermal sutures in wound closure . Methods The investigation comprised 79 patients who underwent elective surgery for bilateral breast procedures . Each breast incision was r and omized to wound closure with the PRINEO ™ Skin Closure System or intradermal sutures ( used in accordance with st and ard local practice ) . Postoperative evaluations took place at 24 hours , 7 days , 12–25 days , 90 days , 6 months , and 12 months . Data were collected on the continuous approximation of the skin edges , the time required to close the include final skin layer , the evaluation of incision healing , and cosmesis outcomes . Safety evaluations were related to the incidence and extent of local acute inflammatory reactions , clinical infection , skin blistering , and adverse events . Results PRINEO ™ Skin Closure System was found to be equivalent to intradermal sutures for the continuous approximation of wounds associated with breast procedures . The upper limit of the one-sided 95 % confidence interval for difference in proportions was less than the predetermined 12 % , at 5.9 % . The mean time to closure for the PRINEO ™ Skin Closure System was 2.56 minutes , which was 13.66 minutes faster than that for intradermal sutures ( 16.22 minutes , P < 0.0001 ) . Time savings may be less if 2 operators close simultaneously . On the other h and , because the device can be applied by 1 operator , the assistant ’s time may be freed up to attend to other tasks . Both treatments had similar incision healing and cosmetic outcomes . No quantitative or qualitative differences of clinical significance were evident between the treatment groups for local acute inflammatory reactions , clinical infection , or skin blistering . The number of serious adverse events was low , although the number of adverse events was higher , with 54/79 patients experiencing at least 1 adverse event . Conclusion PRINEO ™ Skin Closure System can be considered equivalent to intradermal sutures for full-thickness surgical incisions associated with breast procedures , with regard to safety and effectiveness . It was also 6.3 times faster than intradermal sutures for wound closure
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 .