Prehabilitation for Breast Reconstruction Surgery: A Practical and Evidence-based Guide.

BACKGROUND: Prehabilitation, the systematic optimization of physical, nutritional, and psychosocial health before surgery, is well established in other surgical specialties but remains underused and inconsistently defined in breast reconstruction. Patients pursuing reconstruction frequently have modifiable vulnerabilities, including malnutrition, sarcopenia, impaired glycemic control, chronic pain, sleep disturbance, anxiety, and depression, which are associated with higher complication rates, delayed functional recovery, and worse quality of life. METHODS: This review summarizes evidence-supported prehabilitation and perioperative optimization strategies from breast surgery and broader surgical populations and evaluates their relevance to breast reconstruction. We emphasize practical, multidisciplinary screening and targeted intervention across nutrition/metabolism, functional status, pain, sleep, and psychosocial health. RESULTS: Multiple interventions have demonstrated benefit across surgical populations and are readily adaptable to breast reconstruction, including high-protein supplementation and micronutrient optimization, immunonutrition, carbohydrate loading with perioperative glycemic control, resistance training, multimodal pain management, stress-reduction techniques, and sleep hygiene. Implementation requires systematic assessment of nutritional, functional, psychological, and social risk factors and collaboration with dietitians, physical therapists, pain specialists, behavioral health clinicians, and social workers to deliver individualized optimization. CONCLUSIONS: Prehabilitation offers a feasible pathway to improve outcomes and patient experience in breast reconstruction. Prospective studies are needed to define the optimal content, timing, and intensity of multimodal programs and to tailor approaches for implant-based and autologous reconstruction.