key: cord-0818068-uj6miz89
authors: Ganesh Kumar, Nishant; Kung, Theodore A.
title: Guidelines for breast reconstruction during the COVID‐19 pandemic: Are we considering enough evidence?
date: 2020-08-13
journal: Breast J
DOI: 10.1111/tbj.14015
sha: c76df9e3203625268049e30d1818cc9627835573
doc_id: 818068
cord_uid: uj6miz89

nan

In light of the COVID-19 pandemic, on March 24, the American Society of Plastic Surgeons (ASPS) issued guidelines on how to triage breast reconstruction. 1 At the time of this commentary, the current guidelines from the ASPS recommend "caution and [to] delay reconstruction" and that because it is elective, "immediate autologous flap reconstruction for breast reconstruction…should be delayed." It also recommends that "while erring on the side of delayed reconstruction, immediate tissue expander or direct to implant reconstruction can be evaluated on a case-by-case basis." These guidelines echo statements issued by the American College of Surgeons (ACS) that "autologous breast reconstruction should be deferred," and by the Society of Surgical Oncology (SSO) that breast reconstruction "should enable recovery as an outpatient." 2, 3 In settings where reconstruction is not feasible because of a lack of personal protective equipment, reduction in available operating rooms, and limitations in staffing, it is certainly appropriate to delay breast reconstruction. However, when possible, immediate reconstruction should be performed because it has been shown to result in better psychosocial outcomes compared to delayed reconstruction. 4 Immediate reconstruction also avoids the perioperative risks of general anesthesia associated with a second operation and additional out-of-pocket expenses that can occur from an insurance standpoint when breast reconstruction is delayed. From a plastic surgery perspective, immediate reconstruction enables maximal preservation of the native skin envelope and optimizes breast shape and symmetry. Another implication of implant-based reconstruction, specifically tissue expander reconstruction, is the need for serial filling that is typically performed on a weekly basis by clinic staff. In their study, Lemaine et al discovered that implant-based reconstruction was associated with more office visits compared to autologous reconstruction. 6 This frequent need for travel is concerning given the importance of social distancing in preventing the spread of the coronavirus. For example, a recent study from the Harvard School of Public Health found a link between infection rates in neighborhoods in New York City with a high prevalence of the COVID-19 disease, and the number of trips taken by its residents into and out of the neighborhood. 7 From a public health standpoint, this has significant implications when performing tissue expander reconstruction because women who need to undergo weekly expansions will interact with at least one health care provider each time. 

ASPS Statement on Breast Reconstruction in the face of COVID-19 Pandemic

COVID-19 Pandemic Breast Cancer Consortium's Considerations for Re-entry

COVID-19 Guidelines for Triage of Breast Cancer Patients

The psychological impact of immediate rather than delayed breast reconstruction

Autologous versus implant-based breast reconstruction: A systematic review and meta-analysis of Breast-Q patient-reported outcomes

Autologous breast reconstruction versus implant-based reconstruction: how do long-term costs and health care use compare?

Reductions in commuting mobility predict geographic differences in SARS-CoV-2 prevalence in