High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis

Abstract

Purpose As our hospitals conserve and re-allocate resources during the COVID-19 crisis, there is urgent need to determine how best to continue caring for breast cancer patients. During the time window before the COVID-19 critical peak and particularly thereafter, as hospitals are able to resume cancer operations, we anticipate that there will be great need to maximize efficiency to treat breast cancer. The goal of this study is to present a same-day protocol that minimizes resource utilization to enable hospitals to increase inpatient capacity, while providing care for breast cancer patients undergoing mastectomy and immediate breast reconstruction during the COVID-19 crisis. Methods IRB exempt patient quality improvement initiative was conducted to detail the operationalization of a novel same-day breast reconstruction protocol. Consecutive patients having undergone immediate breast reconstruction were prospectively enrolled between February and March of 2020 at Massachusetts General Hospital during the COVID-19 crisis. Peri-operative results and postoperative complications were summarized. Results Time interval from surgical closure to patient discharge was 5.02 ± 1.29 h. All patients were discharged home, with no re-admissions or emergency department visits. No postoperative complications were observed. Conclusion This report provides an instruction manual to operationalize a same-day breast reconstruction protocol, to meet demands of providing appropriate cancer treatment during times of unprecedented resource limitations. Pre-pectoral implantbased breast reconstruction can be the definitive procedure or be used as a bridge to autologous reconstruction. Importantly, we hope this work will be helpful to our patients and community as we emerge from the COVID-19 pandemic.

Impact of Strategies for Mitigating Delays and Disruptions in Cancer Care Due to COVID-19: Systematic Review

“… 24 - 42 Nine studies fully met our inclusion criteria. 43 - 51 The flowchart of the process of study identification and selection is presented in Figure 1 .…”

“…We identified two case series, 49 , 51 three cross-sectional studies, 45 - 47 and four analytical cross-sectional studies. 43 , 44 , 48 , 50 …”

“…The mitigation strategies were implemented in the United States, Italy, and China (two studies each) and Spain, the United Kingdom, and Iran (one study each). Sample sizes ranged from 15 51 to 585. 50 The strategies target health care for nonspecified types of cancers, 44 , 48 - 50 breast cancer, 47 - 51 head and neck cancer, 43 , 45 and lung cancer.…”

The consideration for outpatient mastectomy during the COVID-19 global pandemic

“…Investigations have revealed that outpatient mastectomy is safe and feasible during this global pandemic and now is the time for both surgeons and patients to consider this as the surgical standard for appropriately selected patients. 8 …”

Senology at the time of the coronavirus – What we did or should learn from the COVID-19 pandemic

“…Strategies have been quickly developed, during the 1 st wave, to screen cancer patients requiring medical treatment [18,19], overcome logistic barriers and adapt treatments to limit treatment-related immune deficiency and hospital visits and keep providing optimal breast cancer care. In particular, breast surgery has been often postponed in low-risk cancers [20] and temporarily substituted by preoperative endocrine therapy in Luminal disease [21], immediate reconstructions have been referred [22], hypofractionation has become more widely used, outside of the standard indications [23], weekly chemotherapy schedules have been converted to 3-weekly regimens and oral drugs more widely adopted [24,25], growth factors have been routinely added to avert long lasting G4 neutropenia [26]. Follow-up care for patients out of active treatment has been routinely moved from face to face to virtual visits [27,28] with global satisfaction [29].…”