COVID-associated complications after reconstructive breast surgery: a retrospective cohort study

Abstract

Purpose The COVID pandemic significantly influenced reconstructive breast surgery regimens. Many surgeries were cancelled or postponed. COVID entails not only respiratory, but also coagulative symptoms. It, therefore, potentially increases the risk of postoperative complications. The incidence of perioperative COVID infection and its influence on postoperative recovery after reconstructive breast surgery is still unknown. Methods This dual center retrospective cohort study included patients that underwent reconstructive breast surgery between March 2020 and July 2021. Post-mastectomy autologous or implant-based breast reconstruction (ABR; IBR), as well as post-lumpectomy oncoplastic partial breast reconstruction (PBR) were eligible. Patient data were extracted from electronic medical records. Data regarding COVID-19 infection was collected through a questionnaire. The primary outcome was complication rate. Results The ABR, IBR and PBR groups consisted of 113 (12 COVID-positive), 41 (2 COVID-positive) and 113 (10 COVID-positive) patients. In the ABR and PBR groups, postoperative complications occurred significantly more often in patients with perioperative COVID-infection. Especially impaired wound healing occurred significantly more often in the ABR and PBR breasts, but also at the donor site of ABR patients with perioperative COVID. Conclusion Perioperative COVID-infection increases susceptibility to complicated wound healing after reconstructive breast surgery. A possible explanation lies in the dysregulation of haemostasis by the virus, and its direct effects on microvasculature. A hypercoagulable state results. We recommend to postpone elective breast surgery for 4–6 weeks after COVID-19 infection. Also, precautionary measures remain important to minimize the risk of perioperative COVID-19 infection.

COVID‐19 and skin manifestations

“…8 These effects are further compounded by the virus's capacity to induce microthrombi formation and the deposition of fibrin in collagen fibers, resulting in fibrosis that extends beyond the pulmonary system and infiltrates various organs, including the epidermis. 10 The multifaceted nature of the virus's influence on diverse biological processes translates into a broad spectrum of detrimental consequences for cutaneous healing, which have been welldocumented in clinical settings. Reports have shown an increased susceptibility to surgical site infections, wound dehiscence, skin graft failure, and an array of cutaneous complications, including fibrosis and autoimmune dysregulation.…”