Multidisciplinary Collaboration to Improve Perioperative Care for Breast Reconstruction Patients

The Department of Anesthesiology and Department of Surgery have introduced another Enhanced Recovery After Surgery (ERAS) pathway to UNC in collaboration with the Divisions of Surgical Oncology and Plastic Surgery – one that is specifically dedicated to helping breast cancer patients undergoing mastectomy with immediate reconstruction.

ERAS is a perioperative clinical improvement pathway which utilizes an evidence-based, multidisciplinary approach to standardize patient care and improve patient outcomes. ERAS was first introduced to UNC in 2014, and demonstrated excellent results in decreased length of hospital stay, decreased PACU times, reduction in IV opioid administration, reduced complications, reduction in nausea, and no increases in readmission rates. It has been continuously expanding to other divisions at UNC, helping more patients with every year.

The ERAS pathway will now benefit the breast cancer population by streamlining and improving their quality of care. UNC is a leader in Enhanced Recovery, and is one of the first hospitals to adopt this method of care for breast cancer patients.

After identifying a subset of breast cancer patients as a target population which could benefit greatly, the pathway was specifically developed for them using an evidence-based, multi-disciplinary approach. ERAS leadership team members from the Department of Anesthesiology worked with nursing and surgery colleagues to begin implementation of ERAS components in late summer of 2017.

The ERAS pathway for plastic surgery focuses on streamlining and standardizing the care of patients undergoing mastectomy with immediate reconstruction by placing each patient undergoing this combined procedure onto a special plan dedicated to improving their care. Patients on this pathway will benefit from:

  • a brief educational session in the plastic surgery and surgical oncology clinics
  • a blood pressure assessment in order to identify a target range during surgery
  • multimodal analgesia before, during and after surgery
  • assessment for risk of post-operative nausea and vomiting, and preventative treatments, if necessary
  • targeted anesthesia unique to their procedure
  • minimization of IV opioids

The overall intended benefit of the intra-operative components of the pathway is that the patient wakes up comfortable, with minimal pain and/or nausea. Ideally, patients will be awake and alert, or otherwise returned to pre-procedure status.

It is our hope that with the introduction of this pathway at UNC that patients will be able to return home to their families sooner and more comfortable, and that this will be one of the many ways in which UNC helps them in their treatment with breast cancer.

You can read more about this and other ERAS pathways on our website:

Meet the ERAS-Mastectomy/Reconstruction Team:


Lavinia Kolarczyk, MD, Associate Professor of Anesthesiology and Director of ERAS program


Rob Isaak, DO, Associate Professor of Anesthesiology and Assistant Director of ERAS program


Kate Cobb, MD, Assistant Professor of Anesthesiology and ERAS team champion


Ravindra Prasad, MD, Professor of Anesthesiology and ERAS team champion


Monica Belgado, CRNA, ERAS team champion

Cindy Wu, MD, Assistant Professor of Plastic Surgery and ERAS team champion


Kristalyn Gallagher, DO, Assistant Professor of Surgery and ERAS team champion


Michelle Roughton, MD, Assistant Professor of Plastic Surgery and ERAS team champion


Aaron Lemmon, CRNA champion of ERAS pathways


Lyla Hance, MPH, Manager of ERAS program

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