ABSTRACT
INTRODUCTION: The COVID 19 pandemic caused unprecedented changes in treatment of breast cancer. The aim of this IRB approved retrospective study was to assess trends in surgical management and reconstructive choice after mastectomy during the pandemic. Even as an epicenter at the start of COVID, our hospital prioritized the treatment of breast cancer patients facilitating timely care within accepted standards. METHOD(S): We compared female patients with breast cancer (BC) treated with either lumpectomy (L) or mastectomy (M) during a 12-month period in 2017 and 2020-2021. We stratified based on no reconstruction (NR) versus surgical reconstruction (R), reconstruction using autologous tissue (AT) or tissue expander/implant (TE/I), and age above or below 60 years (< 60, >60). RESULT(S): 399 total patients were treated surgically in 2017 and 2020. In 2017, there were 50 M and 115 L (30.3%/69.7%) versus in 2020, 113 M and 121 L (48.3%/51.7%). In 2017, 9 patients had NR (18.0%) while in 2020, 37 had NR (32.7%). In 2017, 41 had R (82.0%), with 24 receiving AT (58.5%) and 17 had TE/I (41.5%). In 2020, 76 had R (67.3%), with 34 receiving AT (44.7%) and 42 had TE/I (55.3%). For age < 60, 29 had R (70.7%) and 2 had NR (22.2%) in 2017;51 had R (67.1%) and 16 had NR (43.2%) in 2020. For age >60, 12 had R (29.2%) and 7 had NR (77.8%) in 2017;25 had R (32.9%) and 21 had NR (56.8%) in 2020. These data show a 13.8% shift towards TE/I over AT with a 14.7% increase in NR. CONCLUSION(S): Breast cancer patients were prioritized and surgically treated within quality standards. With the changes in availability of hospital resources, staff, and limiting viral exposure, mastectomy rates versus lumpectomy increased dramatically. These trends were possibly due to avoidance of daily facility trips for radiation treatment. Tissue expander/implant rates increased substantially possibly from avoidance of prolonged versus overnight hospital stay. Mastectomy without reconstruction also increased and future studies are needed to determine the number of delayed reconstruction in this group.