Postmastectomy Breast Reconstruction in the Time of the Novel Coronavirus Disease 2019 (COVID-19) Pandemic

Matthew D. Chetta, MD, FACS; Anna R. Schoenbrunner, MD, MAS; Clara N. Lee, MD, MPP

Disclosures

Plast Reconstr Surg Glob Open. 2020;8(6):e2967 

In This Article

Abstract and Introduction

Abstract

Background: Breast reconstruction has a well-documented positive impact on the psychosocial well-being of women recovering from breast cancer. Rates of breast cancer diagnoses are rising, and more women are seeking mastectomy as treatment and as prophylaxis.

Methods: Postmastectomy breast reconstruction often begins at the time of mastectomy in coordination with the oncologic breast surgeons. Immediate breast reconstruction increases complication rate (11% vs 4%) and unplanned reoperation rate (7% vs 4%), requiring more personnel and resources used during the preoperative, intraoperative, and postoperative phases of patient care.

Discussion: In the setting of global pandemics such as coronavirus disease 2019 (COVID-19), breast reconstruction demands a unique and nuanced approach, as most forms of breast reconstruction can occur successfully in a delayed fashion. While this may prolong the overall time until completion of reconstruction, other factors come into play in the setting of a communicable (potentially deadly) illness. Factors that must be considered include allocation of essential resources and protection of patients and families from disease transmission.

Conclusions: Plastic surgeons performing breast reconstruction must take these factors into account when counseling their patients, colleagues, and institutions and be proactive in determining which procedures are time-critical and which should be postponed until the disaster situation has relieved.

Introduction

The novel coronavirus disease 2019 (COVID-19) has quickly become a global pandemic. The American College of Surgeons and the American Society of Plastic Surgeons, in accordance with the Centers for Disease Control guidelines, recommended postponing or canceling elective surgeries.[1,2] The purpose of this recommendation is 2-fold: (1) reducing patient and visitor traffic in healthcare settings to diminish transmission between patients and healthcare staff and (2) preserving vital resources, including hospital beds, critical care and ventilator supplies, and personal protective equipment critical for the protection of patients and healthcare professionals. Many organizations and societies, including the American College of Surgeons, American Society of Plastic Surgeons, Centers for Disease Control, the Centers for Medicare and Medicaid Services, and the Society of Surgical Oncology, have released position statements indicating that breast reconstruction procedures may be considered elective if none of the following criteria are met:

  • threat to the patient's life if surgery is not performed;

  • threat of permanent dysfunction of an extremity or organ system;

  • risk of metastasis or progression of disease; and

  • risk of rapidly worsening to severe symptoms (time sensitivity).[1–5]

Conserving limited resources and preventing disease spread have prompted many healthcare professionals to carefully consider which procedures should be considered time-critical and which may be delayed.

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