The Impact of the COVID-19 Pandemic on Breast Reconstruction: A Canadian Perspective

Abstract

Background: The COVID-19 pandemic has led to unprecedented challenges and restrictions in surgical access across Canada, including for breast reconstructive services which are an integral component of comprehensive breast cancer care. We sought to determine how breast reconstructive services are being restricted, and what strategies may be employed to optimize the provision of breast reconstruction through a pan-Canadian evaluation from the providers’ perspective. Methods: This was a cross-sectional survey of Canadian plastic and reconstructive surgeons who perform breast reconstruction. The 33-item web-based questionnaire was developed by a pan-Canadian working group of breast reconstruction experts and disseminated via email to members of the Canadian Society of Plastic Surgery. The questionnaire queried respondents on the impact of the COVID-19 pandemic and associated restrictions on surgeons’ breast reconstruction practice patterns and opinions on strategies for resource utilization. Results: Responses were received from 49 surgeons, who reported practicing in 8 of 10 Canadian provinces. Restrictions on the provision of breast reconstructive procedures were most limited during the First Wave of the COVID-19 pandemic, where all respondents reported at least some reduction in capacity and more than a quarter reporting complete cessation. Average reported reduction in capacity ranged from 31% to 78% across all 3 waves. Autologous, delayed, and prophylactic reconstructions were most commonly restricted. Conclusion: This study provides a pan-Canadian impact assessment on breast reconstructive services during the COVID-19 pandemic from the providers’ perspective. To uphold the standards of patient-centred care, a unified approach to strategically reorganize health care delivery now and in the future is needed.

The impact of the COVID‐19 pandemic on alloplastic breast reconstruction: An analysis of national outcomes

“…Several studies performed since have shown the strict institutional restrictions placed on all autologous breast reconstructions, with 47.7% of surgeons reporting performing only alloplastic reconstructions during the pandemic, while 15.9% reported restrictions on all forms of breast reconstruction. 30 , 38 , 39 , 40 …”

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

“…21,22 During the pandemic, as recently as Spring 2021, breast reconstruction services were reduced up to 90% across Canadian institutions, with an average of 50% reduction since its onset in March 2020. 3 Breast reconstruction was restricted and not performed following mastectomy, as it is considered an "elective" component of surgical care. This pan-Canadian halt in reconstructive services has created a novel cohort of patients, deemed the "COVID-delayed," and refers to women disadvantaged by pandemic restrictions with irreversibly compromised or delayed reconstruction.…”

“…2 To maintain adequate resources for critically ill patients, provincial governments restricted surgical services according to hospital capacity, resulting in a marked decrease in availability of operative time. 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.…”

“…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 To patient and societal needs, we propose evidence-based strategies to maintain the standard of care with the provision of breast reconstruction during the pandemic. We discuss how these recommendations can be applied according to hospital capacity and available resources.…”

“…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 To patient and societal needs, we propose evidence-based strategies to maintain the standard of care with the provision of breast reconstruction during the pandemic.…”