The feasibility and safety of immediate breast reconstruction in the COVID-19 era

Jallali, Navid; Hunter, JO; Henry, Frances; Wood, Simon; Hogben, Katy; Al-Mufti, Ragheed; Hadjiminas, Dimitri; Dunne, Jonathan; Thiruchelvam, Paul; Leff, Daniel

doi:10.1016/j.bjps.2020.08.044

Cited by 18 publications

(34 citation statements)

References 40 publications

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“…Jallali et al, while asserting that IBR should continue to be recommended, also identified patients with certain comorbidities (BMI > 35 kg/m 2 , diabetes, and chronic cardiac or respiratory disease) who should instead undergo a delayed reconstruction. 24 Further, in the current analysis, we are unable to directly quantify the impact of the added procedure on resource utilization. Mastectomy with immediate reconstruction involves 2 operating teams, greater utilization of PPE, and longer operative times, which decrease the availability of free anesthesiologists and ventilators.…”

Section: Discussionmentioning

confidence: 92%

An Argument for the Safety of Immediate Device Reconstruction following Mastectomy during the COVID-19 Crisis

Huang

Vartanian

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Although oncologic surgery is deemed urgent during the COVID-19 pandemic, clinical guidelines in reconstructive surgery have been unclear. Utilizing propensity-matched pre-pandemic data and our institutional experience during the crisis, we aimed to assess the safety of immediate device reconstruction following mastectomy to aid in decision-making during the pandemic. Methods: Women undergoing mastectomy only and mastectomy with immediate breast reconstruction (IBR) with tissue expander or permanent implant from the 2007–2013 ACS-NSQIP datasets were included. Multivariate analysis of independent variables was used to form propensity-matched cohorts. Incidence of 30-day major postoperative bleeding and hospital length of stay were compared. Results: In total, 13,580 mastectomy only patients and 11,636 IBR patients were identified. Factors that were found to be associated with IBR included age ( P = 0.022), BMI ( P < 0.001), race ( P = 0.010), diabetes ( P = 0.007), chronic steroid use ( P = 0.003), pulmonary disease ( P = 0.004), cardiovascular disease ( P < 0.001), disseminated cancer ( P = 0.001), chemotherapy before surgery ( P = 0.016), low hematocrit ( P < 0.001), and total operative time ( P < 0.001). After propensity matching, immediate device reconstruction following mastectomy was not found to be associated with greater risk of postoperative bleeding (1.4% versus 1.0%, P = 0.334) or increased length of stay (1.5 ± 2.9 versus 1.5 ± 3.5 days, P = 0.576). Conclusions: Immediate device reconstruction does not elevate morbidity in terms of postoperative bleeding or does not increase the length of hospital exposure. Tissue expander or implant reconstruction can be safely performed immediately following mastectomy during the COVID-19 pandemic. Further, our institutional experience during the pandemic indicates that select patients can continue to safely undergo ambulatory mastectomy with device placement.

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Section: Discussionmentioning

confidence: 92%

An Argument for the Safety of Immediate Device Reconstruction following Mastectomy during the COVID-19 Crisis

Huang

Vartanian

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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“…For several months breast reconstruction services were halted. We published guidance on restarting immediate abdominal based reconstructive surgery following mastectomy in the breast cancer setting 1 . This included details of patient selection, COVID-19 testing, and recommended in-patient and out-patient follow-up protocols.…”

mentioning

confidence: 99%

“…During the pandemic, evidence suggested that age over 65 and BMI over 35 increased the risk of severe COVID-related illness 1 . In terms of co-morbidities, our COVID-19 pathway meant that we could no longer offer the surgery to patients with diabetes, those over the age of 70, those with a BMI greater than 35.0, and those with chronic cardiac, respiratory or renal disease.…”

mentioning

confidence: 99%

Immediate autologous free-flap breast reconstruction in the COVID-19 era can be safely performed

Fouarge

Dunne

et al. 2021

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…While the current COVID-19 pandemic appears to be resolving, it is likely that further pandemics, with third and even fourth waves can occur over the coming months and potentially years. Hence, it is imperative that robust protocols are now conceived, to avoid undue delay in decision-making in the future [ 7 ].…”

mentioning

confidence: 99%

The Expander-Implant Breast Reconstruction in the COVID Era: Which is the “Unhappy” Tissue Expander Priority?

et al. 2021

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Breast surgeons seem to agree on the fact that a same-day surgery (mastectomy and breast reconstruction) protocol provides appropriate cancer treatment during times of unprecedented resource limitations, such as in the COVID era. In this scenario, pre-pectoral implant-based breast reconstruction can be definitively considered a sustainable technique. Nevertheless, the authors focus on the management of patients who had already undergone a same day procedure with two-stage breast reconstruction, implanting a breast tissue expander during the last two-year period and have been progressively delayed according to a surgical care based on priority. We coined the expression “unhappy tissue expander” to define all those symptomatic patients for which surgery should not be delayed even during an epidemic context. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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The feasibility and safety of immediate breast reconstruction in the COVID-19 era

Cited by 18 publications

References 40 publications

An Argument for the Safety of Immediate Device Reconstruction following Mastectomy during the COVID-19 Crisis

An Argument for the Safety of Immediate Device Reconstruction following Mastectomy during the COVID-19 Crisis

Immediate autologous free-flap breast reconstruction in the COVID-19 era can be safely performed

The Expander-Implant Breast Reconstruction in the COVID Era: Which is the “Unhappy” Tissue Expander Priority?

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