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PURPOSE: The COVID-19 pandemic uniquely impacted patients with breast cancer as mastectomies were allowed to proceed, yet breast reconstruction surgeries were halted. The purpose of this study was to examine the effect of the COVID-19 pandemic on the rates of breast reconstruction and patients' well-being. METHODS: A chart review included all patients who underwent mastectomy from December 2019 to September 2021. Patients were contacted by a member of the research team and asked to participate in a COVID-19-specific survey and to complete the Hospital Anxiety and Depression Scale (HADS). Patients were then grouped into "surge" or "nonsurge" groups based on the date of mastectomy. RESULTS: Two hundred and fifty-nine patients were included in this study. During the study period, 42% (n = 111) of the patients underwent breast reconstruction. The "surge" group included 106 patients whereas the "nonsurge" group included 153 patients. Fewer patients began breast reconstruction during the surge period compared with the nonsurge period (34.0% vs. 49.0%, p = 0.017). Eighty-six patients participated in the COVID-19 survey. Forty-one percent (n = 35) of the patients felt that their care was disrupted because of COVID-19. Eighty-three patients completed the HADS survey. Overall, 16.8% and 15.7% of the respondents fell into the moderate to severe ranges for both anxiety and depression scales, respectively. CONCLUSIONS: Patients with breast cancer have faced increased difficulties with access to breast reconstruction throughout the COVID-19 pandemic. Our institution demonstrated decreased rates of breast reconstruction and an increase in anxiety and depression. The positive benefits of breast reconstruction cannot be overlooked when determining resource allocation in the future.
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Introduction: The offer of immediate breast reconstruction (IBR) was temporarily withdrawn for women requiring mastectomy during the COVID-19 pandemic to allow prioritisation of emergency care. Many women are now awaiting delayed breast reconstruction (DBR) surgery. This survey aimed to explore the current provision of DBR in the UK and how this had been impacted by COVID-19. Method(s): An online survey was distributed to UK breast units via the ABS/Mammary Fold newsletters and social media feeds between 10/2021 and 04/2022. Simple descriptive statistics were used to summarise the results. Result(s): Of the 42 UK breast units that completed the survey, most units reported that COVID-19 had led to increased waits for DBR. Before the pandemic over three quarters of units reported waits of less than 1 year (29% <6 months, 45% 6-12 months) whereas currently waits of 12-24 months are common with a third of units reporting waits of 24-36 months. A small number of units reported waits of >3 years or that DBR had not yet restarted (14%). Key identified challenges for DBR services included limited availability of theatre time and consultant and/or theatre/nursing staff, and a lack of in-patient capacity for post-operative recovery. Conclusion(s): Waiting times for DBR have been negatively impacted by COVID-19. As reconstruction is an integral part of women's breast cancer treatment, there is an urgent need to develop a recovery plan to address this issue, support patients and allow women to access reconstructive surgery in a timely manner.Copyright © 2023
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Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon and emerging malignancy caused by textured breast implants. The most common patient presentation is delayed seromas, other presentations include breast asymmetry, overlying skin rashes, palpable masses, lymphadenopathy, and capsular contracture. Confirmed diagnoses should receive lymphoma oncology consultation, multidisciplinary evaluation, and PET-CT or CT scan evaluation prior to surgical treatment. Disease confined to the capsule is curable in the majority of patients with complete surgical resection. BIA-ALCL is now recognized as one disease among a spectrum of inflammatory mediated malignancies which include implant-associated squamous cell carcinoma and B cell lymphoma.
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Breast Implantation , Breast Implants , Breast Neoplasms , Lymphoma, Large-Cell, Anaplastic , Humans , Female , Breast Implants/adverse effects , Lymphoma, Large-Cell, Anaplastic/etiology , Positron Emission Tomography Computed Tomography/adverse effects , Breast Implantation/adverse effects , Device Removal , Breast Neoplasms/surgeryABSTRACT
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.
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Introduction Patients' satisfaction after breast reconstruction can be evaluated with validated questionnaires as the Breast-Q questionnaire. The Breast-Q questionnaire includes different domains;one of them is "satisfaction with the result". Material(s) and Method(s): In the multicentre, prospective studies PRO (patient related outcome)-BRA (clinicaltrials.gov: NCT01885572) and PRO-Pocket (clinicaltrials.gov: NCT03868514), patient satisfaction was assessed using the Breast-Q questionnaire. In the PRO-Bra study, 269 patients underwent subpectoral surgery using the TiLOOP Bra polypropylene mesh (pfm medical ag, Germany). In the 'PRO-Pocket' study, 311 patients underwent prepectoral surgery using the TiLOOP Bra Pocket polypropylene mesh. For the evaluation, those patients from the PRO-Bra and PRO-Pocket studies who completed a Breast-Q questionnaire 6 and/or 12 months after surgery were included. The BreastQ score is measured from 0 to 100, with a score of 100 corresponding to 'very satisfied'. Satisfaction with the result of the breast reconstruction was evaluated. Result(s): In the PRO-Bra study, a total of 221 and 203 patients completed a Breast-Q at 6 months and/or 12 months FU, respectively. The mean age and BMI of the patients with completed Breast-Q were comparable between the two studies (PRO-Bra: 49.3 [+/-11.6] years, 22.9 kg/m2 [+/-3.5];PRO-Pocket: 47.7 [+/-11.7] years, 24.5 kg/m2 [+/-4.3]). In the PRO-Pocket study, a total of 258 and 266 patients completed a Breast-Q at 6 months and/or 12 months FU, respectively. In the PRO-Bra study the mean score of satisfaction with the result at 6 months follow-up (FU) was 74.5 (+/-19.9), in the PRO-Pocket 79.1 (+/-19.1), at 12 months FU the mean scores were 76.3 (+/-18.9) for PRO-Bra and 78.2 (+/-20.4) for PRO-Pocket. Furthermore, stratification according to age (cutoff 50 years) or BMI (cutoff 25 kg/m2) did not reveal any differences between the subgroups or the two studies (see Table). PRO-Bra PRO-Pocket mean score (+/-SD) 6 months 12 months 6 months 12 months BMI <= 25 75.1 (+/-19.7) 76.4 (+/-17.8) 77.7 (+/-19.9) 78.9 (+/-19.8) BMI > 25 72.1 (+/-20.7) 76.1 (+/-22.9) 82.1 (+/-16.9) 76.8 (+/-21.8) age <= 50 76.4 (+/-18.7) 77.0 (+/-18.9) 80.1 (+/-18.7) 78.1 (+/-19.6) age > 50 71.5 (+/-21.5) 75.3 (+/-19.0) 77.5 (+/-19.5) 78.4 (+/-21.8) Conclusion(s): Our data so far show high patient satisfaction with overall outcome of the surgery. In addition, patients' satisfaction with the result was comparable after subpectoral as well as prepectoral implant placement. This is particularly important in the PRO-Pocket study, as approximately 60% of the operations and the follow-up period took place during the COVID-19 pandemic.
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BACKGROUND: The positive benefits of immediate prosthesis breast reconstruction (IPBR) are incontrovertible. During the COVID-19 pandemic, health care resources became scarce. The implementation of outpatient immediate prosthesis breast reconstruction (OIPBR) can improve the efficiency of medical care and reduce viral exposure. Very few studies have focused on OIPBR and this study aimed to fill this gap by evaluating outcomes of OIPBR compared with traditional hospitalization IPBR (THIPBR) in terms of complications and quality of life. MATERIAL AND METHODS: The study enrolled patients undergoing IPBR at Tianjin Medical University Cancer Institute and Hospital between January 1, 2020, and September 30, 2021. Outcomes were defined as postoperative complications and quality of life before reconstruction and at 3-month follow-up. Quality of life was assessed by BREAST-Q questionnaire. Inverse probability of treatment weighting and propensity score matching (PSM) were applied to adjust for confounders. RESULTS: A total of 135 patients were enrolled, including 110 with THIPBR and 25 with OIPBR. After matching, baseline characteristics were well balanced. Patients with OIPBR had lower rates of lymphedema on the surgery side (p = 0.041) and readmission (p = 0.040) than patients with THIPBR. No statistically significant differences in the quality of life metrics of psychosocial well-being, sexual well-being, satisfaction with breast and physical well-being of the chest were found between the two groups. CONCLUSION: OIPBR is a safe and efficient alternative to THIBPR during the COVID-19 pandemic. It is recommended when medical conditions allow to conserve medical resources. Accelerated technical training for the performance of OIPBR at the hospital level should be expedited. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Aim: To compare the reoperation and implant loss rates following implant breast reconstruction after 3 months and 5 years in a single unit cohort included in the large multicentre iBRA study1. Method: Patients undergoing implant breast reconstruction for breast cancer or risk reduction mastectomy were recruited as per the iBRA protocol. Electronic patient records were reviewed in December 2021 and reoperation and implant loss was recorded. Results: The records of 26 patients were analysed, all were recruited to the iBRA study. 3-month implant loss (9%) and reoperation rates (18%) were similar to the initial overall study. By 5 years, implant loss rates and reoperation rates had increased to 19% and 77% respectively. 10 patients (39%) underwent 2 or more further operations during this period, with 3 of these patients requiring 5 operations. We acknowledge this cohort is small and any revision procedures performed outside our trust would be missed. Conclusions: Following Montgomery Vs Lanarkshire2 and the Paterson Inquiry Report3, it is vital that patients are aware of any material risk during the consent process before surgery. Quoting 3-month implant loss and reoperation rates in isolation is potentially misleading and there is a need for robust real-life data to guide informed consent. Covid-19 related disruption to elective surgery is inevitable4 and difficult prioritisation decisions are required. Patients undergoing breast reconstruction in 2022 may experience similar complications to the 2016 cohort, however access to revision surgery is uncertain.
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INTRODUCTION: With the pressure to reduce both cost of care and in-patient hospitalizations, particularly in the COVID era, several groups have reported the feasibility of outpatient mastectomies utilizing enhanced recovery after surgery (ERAS) programs. Having converted most mastectomies to the outpatient setting in 2009, we examined our experience sending patients home the same day, including patient selection, unexpected admission and post-operative complications, to better inform institutions considering their own outpatient mastectomy programs. METHODS: With approval from the Institutional Review Board, we performed a retrospective cohort study of patients undergoing mastectomy at a single academic medical center from 2014-2020. Patient population included all patients undergoing mastectomy for malignant disease or risk reduction and excluded patients having immediate breast reconstruction. RESULTS: Of 1678 patients undergoing mastectomy in this time period, 810 did not have immediate reconstruction. Overall, 428 (53%) were planned as outpatient procedures. This was dependent on the type of procedure;unilateral mastectomy (UM) (70%), modified radical mastectomy (MRM) (50%), bilateral simple mastectomies (BSM) (39%) and MRM with contralateral prophylactic mastectomy (MRM/CPM) (25%). The latter two increased over the time course of the study. Admission was associated with ASA status (34% ASA 1/2 vs 51% ASA 3/4, p< 0.001). The most significant predictor was surgeon, with rates ranging from 85% to 46% for UM, 80% to 13% for MRM, 68% to 18% for BSM and 55% to 9% for MRM/CPM. Overall, 16 (3.7%) same-day surgery patients were admitted while 14 (3.8%) 23-hour admission patients were converted to inpatient admissions. Post-operative hematomas requiring a second operation were more common with planned admission compared to those planned for same day discharge (19 (4.9%) vs. 10 (2.3%), p=0.036). CONCLUSIONS: Mastectomies (including bilateral and modified radical mastectomies) without reconstruction can be safely performed on an outpatient basis. Rates of unexpected hospitalizations and post-operative complications are low and there is no difference between those patients planning on same-day discharge and those planned for admission.
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Background: COVID-19 pandemic was a real challenge to healthcare systems worldwide, particularly in emerging nations;this study aims to provide a vision of the impact of COVID-19 pandemic on breast cancer (BC) management and reconstruction in Saudi Arabia. Methods: A cross-sectional study was conducted across health care practitioners;we accumulated data by an online questionnaire from 58 physicians in different specialties about the effect of COVID-19 pandemic on their practice from March 2021 to May 2021. Results: About 45% of participants reduced medical practice during Covid-19 pandemic by 10 - 30 %, and 41% reduced medical practice by 31-50%. About half of the participants (48%) treated less than five breast cancer patients infected by Covid-19, and about 36% of patients developed Covid-19 infection under chemotherapy. Conclusion: there was a considerable reduction in providing health services to patients affected by breast cancer, yet Saudi Arabia managed to get out of this pandemic with the least damage possible due to governmental efforts. In capable countries and organizations, health authorities should share their expertise and experience to prevent damage to people already suffering from a devastating disease like breast cancer.
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Introduction: Prepectoral breast reconstruction (PPBR) has been widely adopted due to a perceived reduction in post-operative pain and improved patient satisfaction but high-quality evidence to support these benefits is lacking. The Pre-BRA prospective multicentre cohort study aimed to explore the safety and effectiveness of PPBR prior to definitive evaluation in an RCT. Here we report the 1st analysis of the 18-month patient-reported outcome (PRO) data. Methods: Consecutive women undergoing PPBR at 40 UK centres were recruited to the Pre-BRA study between July 2019 and Dec 2020 with a 4 month pause to recruitment (March-July 2020) due to the COVID-19 pandemic. Demographic, operative, oncological, and 3-month safety data were collected. Women were asked to complete the BREAST-Q© (V2.0) at baseline, 3 and 18-months. Questionnaires were scored according to the developers' instructions and compared with the 18-month PRO results from the iBRA study which included mainly subpectoral mesh-assisted reconstruction. Results: 347 women underwent PPBR in the Pre-BRA study. Of these, 221 patients recruited pre-COVID have reached 18-month follow-up and 164 (74%) have completed the 18-month questionnaire. The median Satisfaction with Breasts score was 60 (48.5-71;0-100) [inter-quartile range;range] compared to 59 (48-71;0-100) in the UK iBRA study. Conclusions: Satisfaction with breasts at 18-months following surgery appears to be equivalent following pre and subpectoral breast reconstruction. Further analysis is needed, but this study supports the need for an RCT to definitively compare techniques and establish best practice for implant-based reconstruction.
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BACKGROUND: Dual-consultant operating (DCO) has been introduced in a multitude of surgical specialities. This retrospective cohort comparison study seeks to delineate any benefits DCO may confer on list utilisation, patient safety and training opportunities. METHODS: A retrospective cohort comparison of all free-flap breast reconstruction cases conducted at a single centre by five consultant plastic surgeons in the period May 2016-May 2020. RESULTS: A total of 281 patient records were used for analysis; 146 cases were dual consultants compared with 135 single consultants, representing 186 and 158 free flaps, respectively. Patient demographics were near identical in terms of patient age, BMI and ASA grade. Operating times were significantly reduced for both unilateral (mean reduction 59.49 min) and bilateral cases (mean reduction 38.14 min) with the presence of dual consultants. The mean length of stay for dual-consultant cases was on average 0.35 days less than for single consultant cases (p = 0.04). Dual-consultant case complications were less severe than those of single consultant cases (mean Clavien-Dindo severity 1.35 vs 0.96, p = 0.05). The rates of trainee one-to-one consultant training were increased in dual-consultant cases when preparing vessels (0.08 vs 0.35, p=<0.01) and performing anastomosis (0.63 vs 0.77, p = 0.03). CONCLUSIONS: DCO for complex breast reconstruction confers significant benefits to operating time, list utility and patient safety whilst protecting training opportunities for trainees. Plastic surgery departments looking to redesign services in the post-SARS-CoV-19 era should consider its adoption into their enhanced recovery protocols.
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Free Tissue Flaps , Mammaplasty , Surgeons , Consultants , Humans , Mammaplasty/methods , Retrospective StudiesABSTRACT
BACKGROUND: Immediate alloplastic breast reconstruction shifted to the outpatient setting during the COVID-19 pandemic to conserve inpatient hospital beds while providing timely oncologic care. We examine the National Surgical Quality Improvement Program (NSQIP) database for trends in and safety of outpatient breast reconstruction during the pandemic. METHODS: NSQIP data were filtered for immediate alloplastic breast reconstructions between April and December of 2019 (before-COVID) and 2020 (during-COVID); the proportion of outpatient procedures was compared. Thirty-day complications were compared for noninferiority between propensity-matched outpatients and inpatients utilizing a 1% risk difference margin. RESULTS: During COVID, immediate alloplastic breast reconstruction cases decreased (4083 vs. 4677) and were more frequently outpatient (31% vs. 10%, p < 0.001). Outpatients had lower rates of smoking (6.8% vs. 8.4%, p = 0.03) and obesity (26% vs. 33%, p < 0.001). Surgical complication rates of outpatient procedures were noninferior to propensity-matched inpatients (5.0% vs. 5.5%, p = 0.03 noninferiority). Reoperation rates were lower in propensity-matched outpatients (5.2% vs. 8.0%, p = 0.003). CONCLUSION: Immediate alloplastic breast reconstruction shifted towards outpatient procedures during the COVID-19 pandemic with noninferior complication rates. Therefore, a paradigm shift towards outpatient reconstruction for certain patients may be safe. However, decreased reoperations in outpatients may represent undiagnosed complications and warrant further investigation.
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COVID-19 , Mammaplasty , COVID-19/epidemiology , Humans , Mammaplasty/methods , Pandemics , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Reoperation , Retrospective StudiesABSTRACT
INTRODUCTION: The coronavirus disease-19 (COVID-19) pandemic dramatically changed the delivery of breast cancer care. The objective of this study was to quantify the effect of the pandemic on breast cancer screening, treatment, and reconstruction at a single institution in New York City. METHODS: A retrospective chart review was conducted to determine the number of mammograms, lumpectomies, mastectomies, and breast reconstruction operations performed between January 1, 2019 and June 30, 2021. Outcomes analyzed included changes in mammography, oncologic surgery, and breast reconstruction surgery volume before, during and after the start of the pandemic. RESULTS: Mammography volume declined by 11% in March-May of 2020. Oncologic breast surgeries and reconstructive surgeries similarly declined by 6.8% and 11%, respectively, in 2020 compared with 2019, reaching their lowest levels in April 2020. The volume of all procedures increased during the summer of 2020. Mammography volumes in June and July 2020 were found to be at pre-COVID levels, and in October-December 2020 were 15% higher than in 2019. Oncologic breast surgeries saw a similar rebound in May 2020, with 24.6% more cases performed compared with May 2019. Breast reconstruction volumes increased, though changes in the types of reconstruction were noted. Oncoplastic closures were more common during the pandemic, while two-stage implant reconstruction and immediate autologous reconstruction decreased by 27% and 43%, respectively. All procedures are on track to increase in volume in 2021 compared to that in 2020. CONCLUSION: The COVID-19 pandemic reduced the volume of breast cancer surveillance, surgical treatment, and reconstruction procedures. While it is reassuring that volumes have rebounded in 2021, efforts must be made to emphasize screening and treatment procedures in the face of subsequent surges, such as that recently attributable to the Delta and Omicron variants.
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Breast Neoplasms , COVID-19 , Mammaplasty , Breast Neoplasms/epidemiology , Breast Neoplasms/surgery , COVID-19/epidemiology , Female , Humans , Mammaplasty/methods , Pandemics/prevention & control , Retrospective Studies , SARS-CoV-2 , United StatesABSTRACT
Goals: There is no doubt, that Severe Acute Respiratory Syndrome Coronavirus-2 and it’s associated disease (COVID19) has been quite challenging not only for all Health Systems worldwide, but also for all medical professionals, particularly those dealing with cancer patients. There has been a rearrangement of healthcare resources, so that the health systems to be able to deal with the high volume of covid19 patients and the required facilities for their treatment. As a result, routine treatment pathways have been modified. Surgical management of breast cancer patients could not be exempted from treatment pathway modification in the covid19 outbreak era. Main goal is to reduce hospital stay and minimizing the risk for complications and consequently hospital visits, facilitating at the same time oncologic efficiency. Aim of this study is apart from comparing breast surgery cases in two consecutive years, to evaluate the efficacy of therapeutic mammoplasty in breast cancer patients in Covid Outbreak era. Methods: We compared all the breast cases done by a Consultant Oncoplastic Breast Surgeon during covid19 outbreak from March until June in 2020 to the cases done during the same period of time in 2019. Parametres like tumor characteristics, hospital stay, complications, oncologic efficacy, and cosmetic outcome were evaluated. Results: Asseen in theTable1, all breast cases duringCovid19outbreak were cancer cases, without any reconstruction or surgery for benign breast diseases. The number of cases in total was slightly smaller during the outbreak, compared to ones in 2019. As anticipated, there was no reconstruction or benign cases surgery during Covid19 in compliance with Association of Breast Surgery recommendations and regional/national guidelines during Covid19 outbreak. In terms of Wide Local Excisions all of our cases underwent therapeutic mammoplasties, mainly with Modified Round Block technique. (Table Presented) Conclusion(s): In view of Covid19 outbreak, surgical approach to breast cancer patients should ensure oncologic efficiency and minimize exposure to hospital environment. As our data demonstrate, therapeutic mammoplasty is a safe and oncologically efficient approach for breast cancer patients, with minimum complication rates and high satisfaction rates in terms of cosmesis. Therefore, even in challenging pandemic times we are, it can be safely performed by trained Oncoplastic Surgeons. Conflict of Interest: No significant relationships.
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Background: In response to regulations related to the COVID 19 pandemic and to patient demand, an outpatient total mastectomy pathway has been implemented at the Léon Bérard Center (CLB). This study evaluates the implementation of this pathway in terms of postoperative complications and patient satisfaction. Materials and Methods: Observational, retrospective, uni-centric study comparing two care pathways: traditional hospitalization versus outpatient care, for a total mastectomy associated or not with an axillary lymph node procedure. In the outpatient care, a teleconsultation by the coordinating nurses (IDEC) was performed the day after the surgery (D1 postoperative). Patient satisfaction in the outpatient care protocol was assessed by means of a satisfaction questionnaire sent by e-mail, in person or by telephone. Results: Between January 2020 and March 2021, 314 total mastectomies, without immediate breast reconstruction, associated or not with an axillary lymph node procedure, were performed at CLB. Thirty-six patients (11.46%) benefited from the outpatient program. We matched them in age and ASA score with 36 patients who underwent total mastectomy in traditional hospitalization during the same period. The complication rate in our cohort was 54.2%, 30.6% of which were lymphoceles. The postoperative complication rate and the revision surgery rate were not significantly different between the 2 groups (p=0.509, p=0.614). Five patients (13.9%) in the outpatient protocol were converted to traditional hospitalization. No patient in the outpatient program was rehospitalized for a surgical complication. In 66.7% of cases, the teleconsultation on D1 post-operation was carried out between the patient, the IDEC and the nurse in the patient's home who was responsible for the rest of the management. The patients in the outpatient protocol responded to the satisfaction questionnaire in 83.3% of cases. The overall satisfaction rate was rated at 4 or 5 out of 5 in 72.2% of cases. Patients would recommend the outpatient program to a relative in 90% of cases. Conclusions: Our study highlights the feasibility of outpatient total mastectomy, with good patient satisfaction. Teleconsultation at D1 post-op facilitates the link between the surgical management center and the city, favoring continuity of care.
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Background: From September 2018 to June 30 2021 1358 immediate reconstructive procedures were performed by a single reconstructive surgeon in a multi-disciplinary unit. 2000 breast cancer patients were seen over this time This data tracks the types of procedures done and the changes in the procedures including over the time of the SARS COVID19 pandemic. Mastectomies were skin and nipple-sparing (SSM) with implant or autologous reconstruction. Breast-conserving surgery (BCT)had a variety of oncoplastic techniques performed from therapeutic mammoplasties (TM) with opposite side matchings (OSM) and parenchymal flaps (PF) with no OSM. A subset of the BCT had intra-operative radiation therapy. Intra-operative pathology is available for all cases as well as Biovision radiology in theatre. Materials and Methods: Full analysis of the data set was performed on a per-procedure basis, the data set strictly excluded any patient with an incomplete dataset or categorization outside of the study directive to avoid any possible inflation. The data was divided into 2 groups.SSM and immediate reconstruction (either direct to implant(DTI)) or goldilocks mastectomy (GM)and thoraco-epigastric flap (TE)reconstruction or breast-conserving surgery (BCT) with reconstruction. Timelines of what procedures were done each year and the differences per year were analysed Results: For the period of 2018 and 2019, one hundred and three bilateral SSM DTI procedures were performed with six Unilateral SSM and DTI and for the same period ninety-one GM with TE reconstructions For the period of 2020, sixty-one Bilateral DTI and 3 unilateral DTI were performed with twenty-two GM;TE For the first half of 2021 forty bilateral SSM and DTI and, a single unilateral SSM DTI was performed with eight GM;TE Over the same three year period a total of 205 Parenchymal Flap procedures and 559 therapeutic mammoplasties (TM) There was a 99.8% immediate reconstructive rate with no loss of prosthesis over the entire period Conclusions: Whilst the 2020 COVID19 pandemic had a large influence on hospital conditions (restriction of surgical time and bed availability);adaptations within the unit allowed for reconstructive procedures to be offered to all eligible patients, offering every patient immediate reconstruction based on patient-, oncological factors and patient’s preference.
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Keywords: Shoulder rehabilitation;Breast reconstruction;Post-operative function Purpose: Breast Reconstruction patients under the care of Plastic Surgery at NNUH are seen post-op on the ward for breathing exercises, mobilisation, shoulder and donor site exercises and discharge advice. The decision on whether patients require follow-up for shoulder range of movement is down to the physiotherapist, based on patient presentation on discharge from the ward, with patients who are not easily achieving 90 degrees of shoulder flexion and abduction receiving follow-up. The objective of this study was to see if our breast reconstruction patients were regaining good upper limb function and returning to their normal activity in the expected timescales of 12 weeks with our current pre and post-operative physiotherapy care plans, or whether they require further physiotherapy follow-up. Methods: All patients who were listed for reconstructive surgery were asked to complete the Shoulder Pain and Disability Index (SPADI) at their pre-operative appointment with the Reconstruction Specialist Nurse to give a baseline score for shoulder function. All patients received normal treatment (pre-op Breast forum, ward based care, clinic and outpatient appointment follow-up if indicated). Patients were telephoned at target of 12 weeks post op to repeat SPADI and review return to activity, work and to establish if they had any other physiotherapy related ongoing difficulties. Results: 36 patients completed pre-op SPADI, 20 patients completed pre and post op SPADIs and further assessment questions in the study period (October 2019 to March 2020). 16 patients were lost to follow up due to Covid postponing their surgery. Target for follow-up was 12 weeks, this ranged from 12 to 15 weeks. 9 patients had routine clinic follow-up based on clinical need on assessment on ward, with 1 also requiring outpatient appointments. Only 2 patients had a change in score of >18 (Threshold of minimally clinically important change). Both of these patients had IMPROVED scores post op compared to pre-op. For scores worse than pre-op, range was 0–16.1 (not clinically significant). 5 patients had not returned to their hobbies at 12 weeks, but reasons were due to ongoing chemotherapy, shielding for Covid and slow healing wounds. 11 patients had not returned to work, but not because of problems with shoulder function. 3 patients reported ongoing low back pain, 11 had sore or tight donor sites and 3 reported ongoing soreness of their breast. 1 patient reported feelings of low mood and 2 had ongoing fatigue. Conclusion(s): Patients do regain use of their upper limbs to pre-op level in expected timescale with the current treatment regime. It is not shoulder ROM that is restricting return to work or hobbies Many patients reporting tightness of donor site and, in some cases, low back pain. There may be scope for a further study to see if more Physiotherapy input for donor site exercises post-operatively can influence this. Impact: This study suggests that the current level of Physiotherapy assessment and follow up is sufficient to detect patients who will benefit from ongoing therapy. Funding acknowledgements: Not funded.
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Aim: Wire guided localisation(WGL) to localise non-palpable breast tumours has been the standard for years. WGL has limitations;patient discomfort, fixed scheduling to facilitate insertion on the day of surgery and wire migration. A 2015 audit in our department found that 51% of patients undergoing wide local excision (WLE) used preoperative localisation techniques;of which 84% was WGL. The overall re-excision rate for WLE was 27%. We altered our practice to Magseed localisation from July 2019 to improve patient experience, and surgical efficiency, as there are similar outcomes between WGL and Magseed in the literature. This audit aims to examine if there are improvements in our re-excision rate. We aim to evaluate which is the best method for localisation in our department. Method: A retrospective audit was conducted following registration with the local audit office. Patients who underwent breast conserving surgery between September 2019 and September 2020 were identified. The surgical approach, re-excision and complications were recorded and compared to the 2015 results. Results: 100 patients underwent WLE in the study period. The percentage of patients undergoing therapeutic mammaplasty was 26% (14% in 2015). 63% underwent preoperative localisation;of which 71% used Magseed and 5% used wire. The overall re-excision rate was 20%. Conclusions: Our re-audit has demonstrated an increase in patients requiring pre-operative localisation, probably due to the use of primary endocrine treatment during COVID-19. We gladly observed 26% improvement in re-excision rates suggesting success with Magseed.
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PURPOSE: Elective operations including surgeries for breast cancer were significantly reduced during the height of the surge of COVID-19 cases in Massachusetts. The safety of performing breast reconstruction during the pandemic was unknown. This study aims to review the safety of performing mastectomy with immediate breast reconstruction during the first COVID-19 surge in Massachusetts. METHODS: A retrospective chart review of patients who underwent mastectomy with immediate breast reconstruction by Massachusetts General Hospital breast and plastic surgeons immediately preceding and during the COVID-19 pandemic was performed. RESULTS: Thirty patients (34 breasts) underwent mastectomies with immediate breast reconstruction during the COVID-19 restriction period in Massachusetts. Most reconstructions were unilateral. All reconstructions were performed with implants or expanders, and no autologous reconstructions were performed. Two patients (2 breasts) had operative complications. The complication rate during the pandemic was similar to the complication rate pre-pandemic. No patients or surgeons experienced symptoms or positive COVID-19 tests. Over 90% of patients were discharged the same day. CONCLUSION: Prosthetic breast reconstruction was able to be performed safely during the height of the COVID-19 pandemic surge in Massachusetts. Strict screening protocols, proper use of personal protective equipment, and same-day discharge when possible are essential for patient and surgeon safety during the pandemic.
Subject(s)
Breast Implants , Breast Neoplasms , COVID-19 , Mammaplasty , Breast Implants/adverse effects , Breast Neoplasms/complications , COVID-19/epidemiology , COVID-19/prevention & control , Female , Humans , Mammaplasty/adverse effects , Mammaplasty/methods , Mastectomy/adverse effects , Pandemics/prevention & control , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgery , Retrospective Studies , SARS-CoV-2ABSTRACT
INTRODUCTION: COVID-19 has disrupted the provision of breast reconstructive services throughout the UK. Autologous free flap breast reconstruction was restarted in our unit on 3 June 2020. We aimed to compare the unit's performance of microsurgical autologous breast reconstruction in the "post-COVID" period compared with the exact time period in the preceding year. METHODS: We retrospectively reviewed prospectively collected data in the "pre-COVID" (from 3 June 2019 to 31 December 2019) and "post-COVID" period (from 3 June 2020 to 31 December 2020). Patient demographics included age, body mass index, co-morbidities, Anaesthesiologists (ASA) grade and smoking status. Surgical factors included neoadjuvant chemotherapy, previous chest wall radiotherapy, unilateral or bilateral reconstruction, reconstruction timing, number of pedicles, contralateral symmetrisation and other procedures. dependant variables were ischaemic time, operative time, mastectomy weight, flap weight, length of stay, return to theatre and complication rates. The number of trainers and trainees present in theatre was recorded and analysed. RESULTS: Fewer DIEP flaps were performed in the "post-COVID" period (45 vs. 29). No significant difference was observed in mastectomy resection weight, but flap weight was significantly increased. No significant difference was found in ischaemic time as well. The postoperative length of stay was significantly reduced. No significant difference was found in rates of return to theatre, unplanned admission, infection, haematoma, seroma or wound dehiscence. No cases of venous thromboembolism or flap failures were recorded. The mean number of trainers and trainees, and the trainee-to-trainer ratio was not found to be significantly different between cohorts. CONCLUSION: Although fewer cases were performed, autologous breast reconstruction was safely delivered throughout the COVID-19 pandemic in the first wave without affecting training.