key: cord-0814562-oas74lg7
authors: Pace, Bruno Di; Benson, John R.; Malata, Charles M.
title: Breast Reconstruction and the Covid-19 Pandemic: A Viewpoint
date: 2020-05-22
journal: J Plast Reconstr Aesthet Surg
DOI: 10.1016/j.bjps.2020.05.033
sha: aeb29be9958ed169b66372ea04205fab0286dccd
doc_id: 814562
cord_uid: oas74lg7

nan

The Covid-19 pandemic has caused unprecedented disruptions in patient care globally including management of breast and other cancers. 1 However, cancer care should not be compromised unnecessarily by constraints caused by the outbreak.

Clinic availability and operating lists have been drastically reduced with many hospital staff members reassigned to the "frontline". Furthermore, all surgical specialties have been advised to undertake emergency surgery or unavoidable procedures only with shortest possible operating times, minimal numbers of staff and leaving ventilators available for Covid-19 patients. 2 In consequence, much elective surgery including immediate breast reconstruction (IBR) has been deferred in accordance with guidance issued by the ASPS and the Association of Breast Surgery (UK). 3, 4 This will inevitably lead to backlogs of women requiring delayed reconstructive procedures and it is therefore imperative that reconstructive surgeons consider ways to mitigate this and adapt local practice to national guidelines and operative capacity.

In the context of the current "crisis" or the subsequent "recovery period" time consuming and complex autologous tissue reconstruction (free or pedicled flap) should not be performed. Approaches to breast reconstruction might include the following options: ii. "Babysitter" tissue expander/implant: this acts as a scaffold to preserve the breast skin envelope for definitive reconstruction.

3. During the restrictive and early recovery phase, either a solo oncological breast surgeon or a joint ablative and reconstructive team (breast and plastic surgeon) performs surgery without the assistance of registrars or PAs. For joint procedures, the plastic surgeon acts as assistant during cancer ablation and as primary operator for the reconstruction.

Despite relatively high rates of complications for implant-based IBR (risking re-admission, prolonged hospital stays or repeat clinic visits), 5 avoiding all IBR will lead to long waiting lists and have a negative psychological impact, particularly among younger patients. This will also impair aesthetic outcomes due to more extensive scars and inevitable loss of nipples.

Whilst appreciating the restrictions imposed by Covid-19, there is opportunity to offer some reconstructive options depending on local circumstances, operating capacity and the pandemic phase. We suggest that these proposals involving greater use of therapeutic mammaplasty as well as epipectoral/"babysitter" prostheses be considered in efforts to offset some of the disadvantages of Covid-19 on breast cancer patients whilst ensuring that their safety and that of healthcare providers comes first.

Caring for patients with cancer in the COVID-19 era

Maxillofacial Trauma Management During COVID-19: Multidisciplinary Recommendations Facial Plast Surg Aesthet Med

American Society of Plastic Surgeons. ASPS Statement on Breast Reconstruction in the face of COVID-19 Pandemic

Statement from the Association of Breast Surgery 15 th March 2020: Confidential Advice for Health Professionals

Breast Reconstruction Research Collaborative. Short-term safety outcomes of mastectomy and immediate implant-based breast reconstruction with and without mesh (iBRA): a multicentre, prospective cohort study

The authors have no financial interests to declare in relation to the content of this article and have received no external support related to this article. No funding was received for this work.