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 .
A prospective, randomized, controlled clinical trial of tissue adhesive (2-octylcyanoacrylate) versus standard wound closure in breast surgery.
BACKGROUND Recent studies suggest that the use of tissue adhesive for closure of both traumatic lacerations and incisional surgical wounds leads to cosmetic outcome comparable to conventional sutures . To date , no studies have investigated tissue adhesive in breast surgery and costs . Our aim was to compare the tissue adhesive 2-octylcyanoacrylate ( OCA ) with st and ard suture in breast surgery . METHODS A prospect i ve r and omized study was conducted in which 151 patients were assessed for eligibility , and 133 were r and omly allocated to skin closure with OCA adhesive or monofilament suture .  Cosmetic outcome with blinded assessment , wound management by the patients , complication rates , and economic outcome were recorded . RESULTS There was no difference in cosmetic score in the 2 groups , nor in complications at the early , 6-month , and 1-year follow-up . Patient satisfaction with the wound closed with OCA was rated significantly higher when compared with st and ard suture ( P < .0001 ) . The application of the tissue adhesive was significantly faster than that for st and ard suture ( P < .001 ) . In economic terms total costs were less in the tissue adhesive group , mainly due to lower postoperative costs of physician and assistant services ( P < .001 ) . CONCLUSIONS OCA is effective and reliable in skin closure for breast surgery , yielding similar cosmetic results to st and ard suture . OCA is faster than st and ard wound closure and offers several practical advantages over suture repair for patients . Cost analysis has found that OCA adhesive can significantly decrease health care costs
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 .