Optimizing perioperative care in autologous breast reconstruction: a narrative review

Background and Objective: Autologous breast reconstruction is a complex microsurgical procedure in which perioperative management critically influences surgical and patient-reported outcomes. Several physiological and perioperative strategies-including oxygenation enhancement, metabolic modulation, nutritional support and wound care-remain underexplored in this specific setting. This narrative review summarizes evidence on emerging approaches to perioperative optimization in autologous breast reconstruction and discusses their potential to improve recovery and long-term outcomes. Methods: A narrative literature review was conducted using PubMed (MEDLINE, Bethesda, MD, USA) and Scopus (Elsevier, Amsterdam, The Netherlands) for studies published in English up to October 2025. Reference lists of key reviews and consensus statements were manually screened to identify additional relevant publications. The selected literature was analyzed thematically to highlight evolving concepts and their reported impact on reconstructive outcomes. Key Content and Findings: Emerging strategies target perioperative physiology through systemic and local interventions. Hyperbaric oxygen therapy and closed-incision negative pressure wound therapy demonstrate potential benefits in improving perfusion, reducing edema, and lowering wound-related complications. Antioxidant and metabolic modulation, perioperative protein optimization, and preoperative carbohydrate loading may attenuate catabolic stress and support microvascular stability. Structured drain care and infection-prevention protocols further contribute to safer recovery. Evidence remains heterogeneous and limited in scope, but collectively these approaches point toward a more comprehensive and individualized perioperative management paradigm in reconstructive breast surgery. Conclusions: Optimizing perioperative care in autologous breast reconstruction requires an integrated framework that aligns surgical precision with systemic support. Emerging biological and metabolic interventions may complement established recovery practices, potentially improving flap outcomes and overall patient well-being. Prospective multicenter studies are needed to standardize protocols and determine their clinical impact.