Aim: The SARS-CoV-2 pandemic had a significant impact on breast-cancer surgery in the UK. Most breast units were advised to stop immediate breast reconstructions for mastectomy patients. Our unit introduced a policy to offer immediate, pre-pectoral implant-based reconstructions for patients using "Covid-negative" private hospital facilities. A protocol was introduced and outcomes audited.
Method: A retrospective study was conducted; 22 patients underwent mastectomy and breast reconstruction between 31.03.2020 to 24.11.2020. 4 patients were excluded due to incomplete data sets. Data was collected using patient notes, electronic records and an online survey based on the Breast Q/ BR-45 questionnaires.
Results: During this period, 25 operations were undertaken; including 4 revision and 2 symmetrisation procedures. No patients developed COVID-19 during their recovery or follow-up. Patient ASA range was 1-3. 4/18 patients underwent revision surgery for wound refashioning. Risk factors included smoking (2/4), low BMI (1/4) and learning disability (1/4). Average operating time was 124 minutes (including axillary surgery). 10/18 patients had an overnight inpatient stay. 12/18 patients completed the follow-up survey; all patients (12/12) felt safe coming to the breast unit for their treatment, and 10/12 patients stated that a delayed reconstruction would have had a negative psychological impact. 11/12 patients felt they had received sufficient pre-operative information regarding their treatment options and covid risk.
Conclusion: The COVID-19 pandemic has delayed breast reconstruction for large numbers of patients nationwide. We have demonstrated that strict preoperative shielding and covid-negative theatres, allowed the safe continuation of implant-based reconstruction, with a positive impact on our patients.