Day-case approach to immediate breast reconstruction: pushing the boundaries of ambulatory breast surgery in the post-COVID-19 era

Abstract

Introduction Day-case surgery is safe and efficacious for most breast surgical procedures. Limited data exist on its use in immediate breast reconstruction. We present our experience of day-case management of mastectomy with immediate pre-pectoral implant-based reconstruction (IBR). Methods Data were collected on 47 patients who underwent day-case skin-sparing (SSM) or nipple-sparing (NSM) mastectomy with pre-pectoral IBR between October 2017 and September 2019. Clinicopathological data were collected, including postoperative complications, re-admission and re-operation. The data were compared to published national standards. Results Median age was 52 years (range 37–74). Thirty-two patients (68%) had an SSM and 15 (32%) had an NSM. Two patients (4%) had risk-reducing mastectomies and 45 had treatment for invasive cancer or ductal carcinoma in situ (DCIS). Mean tumour size was 33.3mm (range 7–85mm). Forty-two (89%) patients went home on the day of surgery. No patients required re-operation in the first 48 hours. The median postoperative follow-up time was 11.4 months (range 1.8–22.7 months). During the first 90-day postoperative period, eight patients (17%) developed superficial skin necrosis, five patients (10.6%) developed postoperative infections and five patients (10.6%) suffered an implant loss. Eight patients (17%) were readmitted for re-operation. Compared to UK national standards set in the iBRA study, our cohort has demonstrated comparable postoperative infection, implant loss and re-operation and re-admission rates. Conclusion We have demonstrated close to 90% day-case success rate for mastectomy with IBR. These early data suggest that immediate IBR can be carried out in a manner that is cost-efficient without impacting surgical outcomes.

The Safety of Same-day Discharge after Immediate Alloplastic Breast Reconstruction: A Systematic Review

“…Specht et al 25 found, despite a small sample size, no complications were observed in a 30-day postoperative follow-up period of same-day discharge patients. Shaker et al 33 reported findings on immediate implant-based reconstruction, which found comparable rates to national standards in terms of postoperative infection, implant loss, and readmission rates, with no significant difference in overall complications. A series of studies by Dumestre et al 34 in 2017 reported similar data on implant-based reconstruction with same-day discharge compared with overnight admission, and focused on postoperative complications within a 30-day period.…”

Immediate post-mastectomy implant-based breast reconstruction: an outpatient procedure?

“…Previous studies have described outpatient surgical management of immediate implant-based reconstruction; however, each study has significant limitations that can be attributed to one of the following: poor group matching, small sample size, short-term follow-up, lack of controls, strict exclusion criteria (ie, DM, cardiovascular disease, high BMI, smokers, radiation therapy history), limited complication profile, unclear observation and outpatient definitions, or different pain management strategies or surgery settings between groups. 22,[25][26][27][28][29][30][31][32][33][34][35][36] Our study avoids many of these limitations and therefore provides a truer comparison of outpatient versus observation management.…”

“…Although several cohort studies and case series describe patients safely undergoing same-day immediate implantbased breast reconstruction, these studies have significant limitations. 22,[25][26][27][28][29][30][31][32][33][34][35][36] A true comparison between outpatient and inpatient management has not been performed. Therefore, we sought to compare the safety, complications, and cost differences between consecutive patients discharged on the same day of surgery compared with those admitted overnight for observation following immediate prosthetic breast reconstruction.…”

Advancing Immediate Breast Reconstruction Surgery in Pakistan: Bridging Literature Gaps and Meeting Patient Needs

“…Breast reconstruction surgery, specifically immediate breast reconstruction (IBR), has gained prominence in many developed countries as a means to address this challenge. Shaker et al demonstrated close to 90% day-case success rate for mastectomy with IBR [4]. While reconstruction rates vary globally from 5% to 50%, anecdotal evidence suggests that less than 1% of Pakistani women opt for reconstruction [5].…”