PATIENT SAFETY
Breast reconstruction after COVID-19 By Daniel Liu, MD
The modern world has transformed since March 2020 when the COVID-19 pandemic took hold in the United States. COVID-19 affected all aspects of life, resulting in
drastic policy measures in an effort to “flatten the curve.” Early in the pandemic, non-urgent breast reconstruction procedures were restricted by healthcare facilities to protect vulnerable patients and preserve hospital resources. ASPS even recommended that microsurgical autologous breast reconstruction be delayed, due to the need for higher resources and prolonged hospitalization compared with implant-based reconstruction. At the time of this writing, the world has confirmed more than 200 million cases (36 million of those in the United States) of COVID-19, resulting in more than 4.3 million deaths (more than 600,000 in the United States). Multiple waves of infection caused by variants of COVID-19 continue to affect both the economy and healthcare system. However, the introduction of multiple, highly effective COVID-19 vaccines is nothing short of a medical miracle. In other words, COVID-19 has essentially become a preventable disease. Immunized individuals can enjoy a radical risk reduction in contracting the virus, spreading the virus, hospitalization, serious illness and death. This remains the best way that breast cancer patients can protect themselves while undergoing treatments including breast reconstruction surgery. So far in 2021, hospitals in developed countries have not been overwhelmed with COVID-19. Nevertheless, rising hospitalizations among unvaccinated individuals may threaten
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hospital capacity and delay elective procedures again. COVID-19 accelerated the pace of innovation across all specialties treating breast cancer, ultimately improving care and reducing costs. Plastic surgeons embraced the rise of telemedicine to meet new patients and efficiently provide follow-up care without travel. There has been an emphasis on more short-recovery procedures, such as direct-to-implant breast reconstruction. Most surgeons have finally adopted Enhanced Recovery After Surgery (ERAS) protocols, liposomal bupivacaine for pain control and outpatient reconstructions to reduce hospital stay. Some questions remain about potential thrombotic complications after COVID-19 infection, which could affect the risk of undergoing microsurgery, and evidence will be forthcoming. Experts acknowledge that COVID-19 is here to stay. Preoperative screening has become commonplace before surgery and chemotherapy. Antibody-level checks could become part of risk assessment. Infection-control safety protocols remain in place across hospitals and clinics, which limit the number of caregivers to support patients in the hospital. Universal masking will be required in the foreseeable future in healthcare settings. Nevertheless, it is important that women do not put off getting treatment because of COVID-19 fear. Vaccinations are now widely available, and the healthcare system is better equipped to handle spikes in new COVID-19 variant cases. Experience over the past 18 months has shown that immediate breast reconstruction is safe with all of these precautions in place. There is no evidence that either COVID-19 or the vaccine interferes
