# Breast reconstruction perioperative learning portfolio

> **Educational work by a pre-medical student — not medical advice.** Not a clinical protocol, prescription, or patient handout, and not for patient care. See [DISCLAIMER](DISCLAIMER.md).

[Reader’s guide](START_HERE.md) · [Authorship & review status](AUTHORSHIP_AND_REVIEW.md) · [Disclaimer](DISCLAIMER.md) · [Portfolio home](https://collingeorge.github.io/CM-2026/)

This repository studies perioperative anesthesia care for **post-mastectomy breast implant revision and reconstruction**. It is an independent educational portfolio, not a clinical protocol. The historical repository name contains "Protocol"; the materials are structured educational examples. Evidence from primary oncologic breast surgery, augmentation, implant revision and autologous reconstruction must be kept distinct.

## Educational dosing reference — sourced (November 2026)

The modules include an **educational dosing reference**: illustrative doses, rates, maxima, intervals and thresholds.

- **Every number is tagged** (for example, [S6](DOSING_SOURCES.md#s6)) to one entry in [DOSING_SOURCES.md](DOSING_SOURCES.md). Each entry gives the full citation or FDA label and the exact values that source supports.
- **Only acceptable source types are used:** society guidelines and consensus statements, FDA-approved labeling, and score-validation papers.
- **Values without a verifiable source were changed or deleted.** Each change is listed in [RELEASE_NOTES.md](RELEASE_NOTES.md).
- **This is still not a clinical protocol, order set or prescription.** The doses are illustrative, not validated for implant revision, and must be individualized by the treating clinician under institutional policy. Several intraoperative uses (for example, dexmedetomidine as a general-anesthesia adjunct, IV lidocaine, low-dose ketamine) are off-label and are marked as such.

## Contents

- [01 — Preoperative assessment & checklist](01_PreOp_Assessment_and_Checklist.md)
- [02 — Patient counseling script (educational model)](02_Patient_Counseling_Script.md)
- [03 — Analgesic approaches (three examples + comparison)](03_Anesthesia_Protocols/README.md)
- [04 — Surgical workflow (phase sequence)](04_Surgical_Workflow_and_Timeline.md)
- [05 — PACU & discharge](05_PACU_and_Discharge_Instructions.md)
- [06 — References & Evidence](06_References_Evidence_Breast_Augmentation.md) (historical filename retained for links)
- [Pre-induction OR readiness checklist](OR_Checklist_Pre-Induction.md)
- [Dosing sources registry](DOSING_SOURCES.md)

## Applied clinical examples — 28 October 2026

- [Topic-specific paired cases](APPLIED_CASES.md): 7 male/female pairs (14 synthetic profiles), with worked applications, options and source maps.
- [Shared anesthesia options and cases](ANESTHESIA_OPTIONS_AND_CASES.md): the same four-modality guide and 12 general teaching cases used throughout the clinical portfolio.
- [Example format and verification standard](CASE_EXAMPLE_STANDARD.md), [topic source audit](EXAMPLE_SOURCE_AUDIT.json), and [shared source audit](SHARED_SOURCE_AUDIT.json).

These examples use a consistent educational format and source documentation. They do not certify clinical correctness, guideline compliance or patient-care suitability.

## Evidence boundaries

- **Opioid-sparing and opioid-free anesthesia are different concepts.** Avoiding intraoperative opioids does not establish improved overall safety, does not eliminate postoperative opioid needs, and does not justify withholding adequate rescue analgesia. The POFA randomized trial reported important adverse outcomes (hypoxemia, bradycardia) with its dexmedetomidine-based regimen. It cannot be reduced to a universal advantage for either strategy.
- **No universal first-, second- or third-line order.** The three approaches are numbered for reference only.
- **IV lidocaine and local-anesthetic blocks or infiltration are not interchangeable,** and they are not automatically safe to combine after a total-dose calculation. The 2021 international consensus advises against IV lidocaine concurrently with other local-anesthetic interventions, with a separation interval ([S1](DOSING_SOURCES.md#s1)). The modules follow this.
- **Fixed home-care, drain and follow-up timings are not given.** Those instructions come from the treating surgeon.

See [PUBLICATION_REVIEW.md](PUBLICATION_REVIEW.md) for the remaining review requirements, including Git history.

Author: Collin B. George, pre-medical student. Independent educational portfolio; no institutional endorsement is claimed.

License: CC BY 4.0, as stated in [LICENSE](LICENSE). This grants rights in the author's original content only; third-party works retain their own terms. A copyright license is not clinical approval.

Key sources: [IV lidocaine consensus (Foo 2021)](https://doi.org/10.1111/anae.15270); [POFA trial (Beloeil 2021)](https://doi.org/10.1097/ALN.0000000000003725); [2026 ASA local/regional analgesia guideline (Joshi 2026)](https://doi.org/10.1097/ALN.0000000000005790). Full list: [06](06_References_Evidence_Breast_Augmentation.md) and [DOSING_SOURCES.md](DOSING_SOURCES.md).