Enhanced Recovery Program
(ERP)

At the Friedman Center, we want to improve every aspect of your breast reconstruction—including recovery.

An Enhanced Recovery Program (ERP) protocol is an approach to surgical recovery that seeks to hasten patients’ healing after surgery and reduce complications. The Friedman Center has pioneered this postsurgical approach in breast reconstruction and has published a widely used protocol for ERP in breast reconstruction.

Key elements of ERP include:

  • Patient education
  • Smoking cessation
  • Multimodal pain control
  • Minimize use of opioid medication
  • Appropriate use of antibiotics
  • Appropriate prevention of venothromboembolic (VTE) events (blood clots that travel through the bloodstream)
  • Early ambulation
  • Early removal of IVs and urinary catheters
  • Early discharge home from the hospital

The primary benefits of ERP are:

  • Reduced pain
  • Faster recovery
  • Less risk of chronic opioid dependence
  • Less risk of pulmonary emboli (blood clots that lodge in the lungs)
  • Less risk of infection

The Friedman Center’s ERP protocol is designed for patients who have had abdominal flap procedures—a very common type of breast reconstruction. A nerve block (similar to an epidural) is administered to the abdominal region. The block can be so effective that many patients do not need narcotic medication, avoiding nausea, reducing constipation, fatigue, the risk of chronic pain, and drug dependency.

Many women are able to leave the hospital on the second day after surgery, finishing out the recovery process from the comfort of their own homes. In a 2018 study conducted by Friedman Center physicians, patients reported decreased pain levels when the ERP protocol was implemented.

Our physicians have played an instrumental role in developing the ERP protocol for microsurgical breast reconstruction and can provide you with additional details.