Management of Breast Reconstruction Salvage in the COVID-19 Pandemic Era: Is there still Room for Plastic Surgery?

Abstract

Implant infection after breast reconstruction is always disastrous and often leads to the need to remove the prosthesis and delayed reconstruction. In those cases when conservative treatments fail (i.e., oral or i.v. antibiotics), a surgical approach is necessary. Removing the implant and debridement are always required, but which are the following reconstructive steps? In the literature, different solutions chosen based on the severity of the infection are described. In the pandemic Covid-19 era, the healthcare system has to deal with a significant restriction in the delivery of surgical services due to the recruitment of hospital staff members to the “Covid-19 frontline”. Although implant removal for infection represents an urgent deferred procedure, the reconstruction is not considered as such. Here we report on a case of breast reconstruction with Deep Inferior Epigastric Perforator (DIEP) flap in a patient having a severe implant infection during the Italian second wave of the pandemic (February- March 2021). Initially, she was locally treated with the removal of the implant and the simultaneous application of negative wound pressure therapy with irrigation in the pocket site, which led us to an “immediate” reconstruction (10 days after implant removal) with a DIEP flap.