Perioperative Protein and Vitamin Supplementation in Plastic Surgery: An Evidence-Based Proposal for an Assessment and Replacement Protocol

Wound complications, dehiscence, and surgical-site infection remain relevant determinants of aesthetic and functional outcomes in plastic surgery and appear to bear a measurable relationship with the patient’s perioperative nutritional status. The progressive incorporation of Enhanced Recovery After Surgery (ERAS) protocols into plastic surgery, particularly in autologous breast reconstruction and post-bariatric body contouring, has increasingly positioned preoperative nutritional optimization as a structural component of care rather than an optional adjunct. This narrative review consolidates current evidence on perioperative protein and vitamin supplementation (covering a window of approximately seven to fourteen days before and after surgery) in plastic surgery, with a focus on American and European literature and on consensus guidelines from the ERAS Society and European Society for Clinical Nutrition and Metabolism. Hypoalbuminemia emerges as one of the more consistently reported predictors of postoperative morbidity in plastic surgery National Surgical Quality Improvement Program analyses, although the strength of this association is not uniform across studies; immunonutrition with arginine and omega-3 fatty acids has relatively robust support in major surgery and has already been incorporated into ERAS pathways for breast reconstruction. Patients undergoing post-bariatric body contouring appear to represent a higher-risk population, with a reported high prevalence of iron, vitamin B12, vitamin D, zinc, and protein deficiencies. From this evidence base, we propose a structured protocol combining preoperative laboratory screening, risk stratification, and targeted replacement of documented deficiencies, accompanied by oral protein supplementation and, in selected cases, immunonutrition. The protocol aims to balance clinical applicability and methodological caution, restricting recommendations to interventions with reasonably consistent evidentiary support.