Breast Reconstruction for Cancer Patients in COVID-19 Pandemic.

Abstract

Breast reconstruction is considered an integral aspect of breast cancer treatment and has a well-known positive effect on quality of life. Surgical treatment of cancer has been delayed until evaluation of local circumstances of coronavirus disease of 2019 (COVID-19), adding to reasons why breast reconstruction procedures may have been delayed.1 In developing countries and middle-income economies, breast reconstruction has had a slow growth; even now, some countries do not cover breast reconstructive surgery, and we were just starting to see progress on the subject in recent years.2 We think breast reconstruction should not be abandoned as an important subject in benefits for cancer patients, even during this pandemic. At our institutions, we continue to offer breast reconstruction surgery, even during the COVID-19 pandemic (Fig. 1). To achieve this, we offer short-recovery surgical procedures to reduce patient exposure to coronavirus. We even try to favor a same-day surgery approach. This could mean direct-to-implant surgery when feasible or tissue expander placement when a second surgery would be required. We also look for options that reduce patient hospital stay, such as enhanced recovery after surgery protocols; combined anesthesia, with local blockades to reduce the effects of intravenous medications (e.g., nausea and vomiting) to favor shorter hospital stays; and oral intubation to contain aerosolization of virus for the protection of the surgical team.3 Immediate reconstruction will favor less exposure to coronavirus, avoiding at least one subsequent surgery and hospitalization.Fig. 1.: Proposed approach for breast reconstruction during the COVID-19 pandemic. DIEP, deep inferior epigastric perforator; SIEA, superficial inferior epigastric artery; SGAP, superior gluteal artery perforator; IGAP, inferior gluteal artery perforator; PAP, profunda artery perforator; TUG, transverse upper gracilis.There have been reports of thrombosis complications secondary to coronavirus infection.4 In this scenario, microsurgery procedures could be delayed until we have more and better knowledge, or at least new data and evidence of perioperative complications in elective microsurgery procedures. When the possibility of radiation was present, or after a shared decision-making approach, we opted for microsurgical free flap reconstruction, a tissue expander would be a better option to delay flap surgery at least 6 months, so we can offer a better safety profile. Offering immediate lymphatic reconstruction would offer higher benefits in these circumstances, to avoid new surgical procedures when possible, in addition to its established benefits.5 Nowadays, coronavirus infection considerations should be part of the shared decision-making process, and first consultation could be performed through virtual online options and three-dimensional models, as well as some follow-up consultations. Breast reconstruction should be considered in breast cancer patients even during the actual COVID-19 pandemic, and time will tell which is the best approach. For now, we should be proactive with caution. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.