Breast Reconstruction during the COVID-19 Pandemic: A Systematic Review

Abstract

Introduction:The COVID-19 pandemic posed unique challenges for breast reconstruction. Many professional organizations initially placed restrictions on breast reconstruction, leading surgeons to conceive innovative protocols for offering breast reconstruction. This study reviewed the current evidence on breast reconstruction during the COVID-19 pandemic to provide guidance for surgeons facing future crises. Methods: The MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews were searched for studies (1) describing implant and autologous breast reconstruction following mastectomy and (2) occurring during or pertaining to the COVID-19 pandemic. Results: Of the 1347 studies identified, 26 were included. Studies discussed type of reconstruction (18, 69%), complications (11, 42%), timing of reconstruction (10, 38%), protocols (10, 38%), COVID-19 screening (7, 27%), and length of hospital stay (7, 27%). The type of reconstruction varied depending on the stage of the pandemic: early on, autologous breast reconstruction was halted to preserve resources, but was later resumed. Within implant-based reconstruction, direct-toimplant was favored over serial tissue expansion. Several protocols were developed, with many emphasizing multidisciplinary collaborations for patient selection, use of specialized measures to reduce risk of COVID-19 transmission, and optimization of same-day discharge. Complication rates following breast reconstruction were similar to pre-pandemic rates. Conclusions: The COVID-19 pandemic has forever changed the landscape of breast reconstruction by raising important questions about delivery of care, cost, and resource utilization. The findings of this review may inform surgeons as they plan for similar future crises or strive for improved patient care and efficacy even during nonpandemic times.

The COVID-19 Pandemic Consequences on Microsurgical Reconstructions: A Single Center’s Shift of Indications

“…The reduced number of autologous BRs seen during the COVID-19 year (from 66 the year before COVID-19 to 38 in the COVID-19 year) was expected because a vast majority of them are performed as elective surgery in a secondary setting at our hospital. This reduction is in line with the results recently presented by Hemal et al 9 The largest difference is seen in period 1, representing the first wave of the COVID-19 pandemic in Stockholm when all autologous BR surgeries were canceled. The second COVID-19 wave in Sweden seen during period 4 in Figure 2 C also shows a reduction in the number of surgeries, but not as severe as the first wave.…”

Effects of COVID‐19 on mastectomy and breast reconstruction rates: A national surgical sample

“…11 The ACS guidelines eventually permitted autologous reconstruction, depending on the phase of the pandemic, geographic location, and available resources at the treating institution. 12 …”

Canadian Expert Opinion on Breast Reconstruction Access: Strategies to Optimize Care during COVID-19

“…1,3 For breast cancer patients in whom surgery is the mainstay treatment of choice, surgical care has been delayed and/or compromised. 4 Breast reconstruction following tumor ablation is considered an integral and standard component of comprehensive cancer care, offering women facing mastectomy the choice of restoration. Despite its essential role, breast reconstruction was severely restricted during the pandemic, with irreversible long-term consequences for Canadian breast cancer survivors.…”

“…3,5,6 Amidst robust vaccination programs, there are current and persistent strains on the healthcare system which demand continued efforts to efficiently deliver breast reconstructive services. 3,4…”