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Home Recovery After Mastectomy: Review of Literature and Strategies for Implementation American Society of Breast Surgeons Working Group

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Practices regarding recovery after mastectomy vary significantly, including overnight stay versus discharge same day. Expanded use of Enhanced Recovery After Surgery (ERAS) algorithms and the recent COVID pandemic have led to increased number of patients who undergo home recovery after mastectomy (HRAM).

Methods

The Patient Safety Quality Committee of the American Society of Breast Surgeons created a multispecialty working group to review the literature evaluating HRAM after mastectomy with and without implant-based reconstruction. A literature review was performed regarding this topic; the group then developed guidance for patient selection and tools for implementation.

Results

Multiple, retrospective series have reported that patients discharged day of mastectomy have similar risk of complications compared with those kept overnight, including risk of hematoma (0-5.1%). Multimodal strategies that improve nausea and analgesia improve likelihood of HRAM. Patients who undergo surgery in ambulatory surgery centers and by high-volume breast surgeons are more likely to be discharged day of surgery. When evaluating unplanned return to care, the only significant factors are African American race and increased comorbidities.

Conclusions

Review of current literature demonstrates that HRAM is a safe option in appropriate patients. Choice of method of recovery should consider patient factors, such as comorbidities and social situation, and requires input from the multidisciplinary team. Preoperative education regarding pain management, drain care, and after-hour access to medical care are crucial components to a successful program. Additional investigation is needed as these programs become more prevalent to assess quality measures such as unplanned return to care, complications, and patient satisfaction.

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Acknowledgment

The authors thank Mena Jalali and Sharon Grutman for their administrative efforts on this project and the Executive Board of the American Society of Breast Surgeons for its support of this workgroup. They also thank Sara Fluharty (perioperative nursing representative) and Eileen Fuentes (patient advocate) for their participation in this project.

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Authors and Affiliations

  1. Indiana University School of Medicine, Indianapolis, IN, USA

    Kandice Ludwig MD

  2. Trihealth Cancer Institute, Cincinnati, OH, USA

    Barbara Wexelman MD & Sara Fluharty RN

  3. OasisMD, San Diego, CA, USA

    Steven Chen MD, MBA

  4. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Gloria Cheng MD

  5. MD Anderson Cancer Center, Houston, TX, USA

    Sarah DeSnyder MD

  6. Venice, FL, USA

    Negar Golesorkhi MD

  7. Yale University, New Haven, CT, USA

    Rachel Greenup MD

  8. Harvard Medical School, Boston, MA, USA

    Ted James MD, MBA, MPH & Bernard Lee MD

  9. Mayo Clinic, Scottsdale, AZ, USA

    Barbara Pockaj MD

  10. Kaiser Permanente Medical Center, Sacramento, CA, USA

    Brooke Vuong MD

  11. New York, NY, USA

    Eileen Fuentes

  12. Columbia University, New York, NY, USA

    Roshni Rao MD

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  1. Kandice Ludwig MD
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  2. Barbara Wexelman MD
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  3. Steven Chen MD, MBA
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  14. Roshni Rao MD
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American Society of Breast Surgeons Patient Safety Quality Committee

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Correspondence to Kandice Ludwig MD.

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Ludwig, K., Wexelman, B., Chen, S. et al. Home Recovery After Mastectomy: Review of Literature and Strategies for Implementation American Society of Breast Surgeons Working Group. Ann Surg Oncol 29, 5799–5808 (2022). https://doi.org/10.1245/s10434-022-11799-4

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