Goo‐Hyun Mun

Background When choosing a method of deep inferior epigastric perforator (DIEP) flap for breast reconstruction, concerns regarding the potentially detrimental effects of obesity on postoperative recovery remain. Enhanced recovery after surgery (ERAS) is known to facilitate rapid postoperative recovery. This study aimed to examine the effect of the ERAS protocol on the disparity between normal/underweight and overweight/obese patients after DIEP flap breast reconstruction. Methods A retrospective review of consecutive patients who underwent DIEP flap breast reconstruction between January 2015 and November 2022 was conducted. The patients were categorized into two groups: pre‐ERAS and post‐ERAS. In each group, associations between overweight/obese patients (BMI ≥25 kg/m 2 ) and postoperative course were evaluated. Results In total, 217 patients in the pre‐ERAS group (including 71 overweight/obese) and 165 in the post‐ERAS group (including 58 overweight/obese) were analyzed. The post‐ERAS group had shorter length of stay (LOS) (8.0 versus 7.0 days, p ‐value <.001) and lower postoperative pain scores (5.0 versus 3.0 at postoperative day (POD) 1, p ‐value <.001) than the pre‐ERAS group. The complication profiles did not differ according to ERAS adoption. In the pre‐ERAS group, overweight/obese patients showed a significantly longer LOS (8.0 versus 9.0 days, p ‐value = .017) and a higher postoperative pain score (3.0 versus 4.0 at POD 2, p ‐value = .018) than normal/underweight patients; however, these differences disappeared in the post‐ERAS group, showing similar LOS, pain scores, and analgesic consumption. Conclusions Implementation of the ERAS protocol in DIEP free‐flap breast reconstruction may reduce overweight/obesity‐related disparities in postoperative recovery.