J Reconstr Microsurg 2020; 36(07): 480-485
DOI: 10.1055/s-0040-1708834
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Optimizing Postoperative Pain Control in Autologous Breast Reconstruction: A Systematic Review

Rebecca Knackstedt
1  Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
2  Department of Biomedical Engineering, College of Engineering, University of Utah, Salt Lake City, Utah
3  School of Dentistry and School of Medicine, University of Utah Health, Salt Lake City, Utah
James Gatherwright
4  Division of Plastic Surgery, MetroHealth, Cleveland, Ohio
› Author Affiliations
Funding None.
Further Information

Publication History

11 October 2019

02 February 2020

Publication Date:
14 April 2020 (online)


Background Pain management approaches in autologous breast reconstruction have become a topic of great interest in the era of enhanced recovery after surgery protocols, as well as the opioid epidemic. The management of postoperative pain is of critical importance for women undergoing breast reconstruction; however, these protocols have yet to be synthesized and compared in the primary literature. Herein, we present a systematic review of approaches to provide optimal pain control while minimizing narcotic use and its associated potential negative sequelae in autologous breast reconstruction.

Methods A comprehensive systematic review of the published literature was conducted using Ovid Medline/PubMed database without timeframe limitations, in compliance with the guidelines outlined in the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Inclusion criteria were selected for studies reporting objective outcomes of pain modulation in autologous breast reconstruction. Articles for inclusion were stratified based on intervention.

Results A total of 101 articles were identified on initial search query. After full-text review and final screening of all articles and review of included studies’ references, 28 studies met the inclusion criteria and were analyzed.

Conclusion There continues to be a substantial need for evidence-based guidelines in the plastic surgery literature. Mitigating postoperative pain can improve health-related quality of life, reduce health care resource utilization and costs, and minimize perioperative opiate use. Given the increasing popularity of and access to autologous approaches to breast reconstruction, we hope this area of study continues to be a top priority for plastic surgeons to allow for optimized postoperative care.