The widespread restrictive measures used to control the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection include but are not limited to social distancing and temporary shutdown of schools, companies and recreational facilities. These dramatic shifts in lifestyle implemented in a short time-frame have inadvertently exposed a darker social scenery that challenges the well-being and development of a generation of children and adolescents globally. The pandemic has stretched the capacity of healthcare providers and home caregivers in resource-rich and resource-limited economies, leaving many children in circumstances that offer limited physical, infrastructural, emotional and social support. Examples of lifestyle changes include replacement of in-person schooling with virtual education, loss of social interaction with teachers, friends, and peers, cessation of extra-curricular activ-'flattening the curve' for new SARS-CoV-2 infections. As a result, children are at home for longer periods of time. Although home should be the safest place for a child, sexual, psychological and physical abuse can occur. Rates of domestic violence and partner abuse have increased globally impacting women and children most
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Background: Prepectoral implant-based breast reconstruction has gained popularity because of advantages over the subpectoral technique. Acellular dermal matrix use with implant-based breast reconstruction has become common because of its perceived superior aesthetic outcome. Matrices are expensive, however, and recent evidence has pointed to several potential complications. This article reports a series of prepectoral implant-based breast reconstructions with and without acellular dermal matrix and compared their outcomes. Methods: This is a single-surgeon retrospective review of patients who underwent staged prepectoral implant-based breast reconstruction following nipple-sparing mastectomy over two periods. Patients with well-perfused mastectomy skin flaps with a homogeneous thickness underwent reconstruction with acellular dermal matrix initially. On evolution of the practice, it was not used. Patient demographics, operative data, and complications were analyzed. Aesthetic outcome was measured by the BREAST-Q survey and the Aesthetic Item Scale. A cost analysis was also performed. Results: Forty patients were included (acellular dermal matrix group, n = 19; non–acellular dermal matrix group, n = 21). The nonmatrix group had one case (5 percent) of seroma and one case (5 percent) with hematoma; there were none in the acellular dermal matrix group. Average BREAST-Q and Aesthetic Item Scale scores were 82.3 versus 81.6 (p = 0.954) and 20.98 versus 20.43 (p = 0.640) for the matrix and nonmatrix groups, respectively. The direct cost savings for the authors’ institution over 1 year if matrix was not used in all cases of implant-based breast reconstruction would be estimated at $3,105,960 to $6,211,920 for unilateral and bilateral cases, respectively, for Medicare reimbursement. Conclusions: With adequate patient selection, acellular dermal matrix is not always required during two-stage prepectoral implant-based breast reconstruction for good aesthetic outcomes. The economic burden on patients and the health care system could be lessened with selective matrix use. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
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