Dear Sir,
For breast cancer, partial and total breast reconstruction reduce patient's sensation of mutilation, improving their quality of life. On the other hand, the pandemic of the COVID-19 resulted in the implementation of social distancing measures, with a negative effect on the management of different diseases. We read the article of Di Pace et al. entitled “Breast reconstruction and the COVID-19 pandemic: A viewpoint1”. We agree that risk-reducing surgeries, contralateral operation and revisional procedures should be postponed. However, as the authors pointed out, “avoiding all IBR will lead to long waiting lists and have a negative psychological impact, particularly among younger patients”. We believe that immediate breast reconstruction (IBR) should be recommended, especially with implants or tissue expanders, considering local conditions during the pandemic.
In Brazil, there was an increase in the proportion of patients undergoing breast reconstruction between 2008 and 2014, but the rates are still low (29%)2: there are a considerable number of patients waiting for delayed breast reconstructions. After the pandemic outbreak, most of IBR has been deferred in accordance with guidelines elaborated by experts.3 This may have impacted IBR rates in Brazil. We evaluated the opinion of the Brazilian breast surgeons from the Brazilian Society of Mastology (SBM),4 through an electronic survey carried out during April and May this year: we created questions regarding breast cancer treatment, including breast reconstruction, partial or total, and prophylactic surgery.
After approval of the SBM's internal review board, the questionnaire was sent to 1462 Brazilian surgeons. 503 mastologists returned the questionnaire. Overall, 319 (64%) of respondents would recommend IBR, while 36% would contraindicate it. Among those who recommended IBR, direct to implant techniques would be the preferred method (55%), while 40% would recommend temporary tissue expander. Only 3% of surgeons would recommend myocutaneous flaps. For partial reconstruction after breast-conserving surgery, 75% would recommend minor procedures, however 54% would contraindicate mammoplasty techniques. Finally, 15% of respondents would recommend risk-reducing surgery for patients with BRCA deleterious mutations.
These data may provide further information on breast reconstruction surgery in Brazil during the pandemic: although most respondents suggested opting for IBR, about 1/3 of the mastologists would not recommend it, and half of the respondents would not recommend mammoplasty. If this behavior obtained through this survey reflected the real treatment of patients during the pandemic, we will possibly have greater pressure on the Brazilian public health system (SUS) in the near future. We will need to design strategies to minimize the waiting list for reconstructive breast surgeries in Brazil.
Ethical approval
N/A.
Declaration of Competing Interest
The authors declare no conflict of interests.
Funding source
None.
References
- 1.Di Pace B., Benson J.R., Malata C.M. Breast reconstruction and the COVID-19 pandemic: a viewpoint. J Plast Reconstr Aesthet Surg. 2020;73(7):1357–1404. doi: 10.1016/j.bjps.2020.05.033. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Freitas-Júnior R., Gagliato D.M., Moura Filho J.W.C., Gouveia P.A., Rahal R.M.S., Paulinelli R.R. Trends in breast cancer surgery at Brazil's public health system. J Surg Oncol. 2017;115(5):544–549. doi: 10.1002/jso.24572. [DOI] [PubMed] [Google Scholar]
- 3.American Society of Plastic Surgeons. ASPS statement on breast reconstruction in the face of COVID-19 pandemic. 2020. Available at:https://www.plasticsurgery.org/documents/medicalprofessionals/COVID19-Breast-Reconstruction.
- 4.Cavalcante FP, Novita GG, Millen EC, Zerwes FP, de Oliveira VM, Sousa ALL et al. Management of early breast cancer during the COVID-19 pandemic in Brazil, 2020, PREPRINT (Version 1) available at Research Square, 10.21203/rs.3.rs-41941/v1+. [DOI] [PMC free article] [PubMed]