Breast reconstruction during the COVID-19 pandemic

Abstract

Background:The novel coronavirus disease 2019 (COVID-19) has changed people's way of life and posed great challenges to plastic surgery. Most of plastic surgeries are considered elective surgeries and are recommended to be delayed. But breast reconstruction in plastic surgery is special. Doctors’ associations from different countries have different rules on whether breast reconstruction surgery should be delayed. For the controversial topic of immediate breast reconstruction in the COVID-19 pandemic, we conducted this study.Methods:We searched English databases such as PubMed, Cochrane Library, and Embase. The publication time of papers was set to be from the establishment of the databases to February 2021. All studies on immediate breast reconstruction in the COVID-19 pandemic were included in our study.Results:A total of 6 studies were included in this study. Four studies recommended the use of breast implants or tissue expansion for breast reconstruction surgery and had good results in their clinical practice. In addition, 1 study planned to use autologous free tissue transfer for breast reconstruction, and 1 study planned to use microsurgical techniques for breast reconstruction. But these 2 technologies are still in the planning stage and have not yet been implemented.Conclusions:In our opinion, breast cancer surgery belongs to confine operation, and breast reconstruction surgery should be performed immediately after the completion of breast cancer surgery. We recommend the use of breast implants for breast reconstruction surgery during the COVID-19 epidemic. Due to the limitations of the study, our proposed protocol for breast reconstruction surgery during the COVID-19 epidemic needs to be further validated in clinical studies.

The impact of the COVID‐19 pandemic on alloplastic breast reconstruction: An analysis of national outcomes

“…Several studies performed since have shown the strict institutional restrictions placed on all autologous breast reconstructions, with 47.7% of surgeons reporting performing only alloplastic reconstructions during the pandemic, while 15.9% reported restrictions on all forms of breast reconstruction. 30 , 38 , 39 , 40 …”

“…At the same time, the ASPS recommended in March 2020 that autologous reconstructions are delayed and immediate alloplastic reconstruction be performed on a case‐by‐case basis, depending on resource availability, the patient's comorbidities, and the likelihood of complications. Several studies performed since have shown the strict institutional restrictions placed on all autologous breast reconstructions, with 47.7% of surgeons reporting performing only alloplastic reconstructions during the pandemic, while 15.9% reported restrictions on all forms of breast reconstruction 30,38–40 …”

“…To conserve resources while still providing care for breast cancer patients, some centers pivoted to “high‐efficiency” same‐day protocols with encouraging early outcomes. 27 , 28 , 29 , 30 …”

“…Given that cancer patients are at higher risk for serious complications and mortality from COVID‐19, 25,26 these recommendations provided a strong incentive to provide immediate reconstruction in the outpatient setting. To conserve resources while still providing care for breast cancer patients, some centers pivoted to “high‐efficiency” same‐day protocols with encouraging early outcomes 27–30 …”

“…To conserve resources while still providing care for breast cancer patients, some centers pivoted to "high-efficiency" same-day protocols with encouraging early outcomes. [27][28][29][30] Despite the observed delays and global decreases in elective surgical volumes, relatively little is known about the effects of the COVID-19 pandemic on outcomes of breast reconstruction on a national scale. Understanding how these necessary changes have affected outcomes will inform decision-making for breast cancer surgeons and patients, as the availability of inpatient surgery returns.…”