Does rapid discharge after breast cancer surgery have an impact on wound healing and complications? COVID-19 pandemic experience.

The COVID-19 pandemic has challenged the health systems worldwide. Because of high volume of COVID-19 patients, all hospitals in our region were re-configured as COVID-19 centres and elective surgery procedures were cancelled. Our clinic was the only active centre in the region and grave increase in our patient volume urged our clinic to modify our discharge protocol. This retrospective study included all breast cancer patients underwent mastectomy and/or axillary dissection, in the Breast Surgery Clinic of Kocaeli State Hospital, a regional pandemic hospital, between December 2020 and January 2021. Patients were mostly discharged the day of surgery with drains because of congestion, while some of the patients had traditional stay, when beds were available. The patients were evaluated postoperatively (the first 30 days) in terms of wound complications, Clavien-Dindo classification grade, satisfaction, presence of pain and nausea, and treatment costs during the follow-up period of the study. Outcomes were compared between early discharged patients and patients who had traditional long stay. Compared with long-stay patients, in the early discharged group, postoperative wound complications was significantly lower (P < .01) with significant cost savings. There were no significant changes in variables such as surgery type, ASA class, satisfaction, need for additional medication and Clavien-Dindo between the groups. Adaptation to an early discharge protocol for breast cancer surgeries may be an efficient way of practicing surgery in a pandemic. Early discharge with drains may be beneficial for patients.

Surgical outcomes of breast conserving surgery performed under local versus general anaesthesia

Background: Surgical resection remains the mainstay for early breast cancer. However, older patients with multiple co-morbidities may be deemed unsafe for general anaesthesia (GA). The Covid-19 pandemic necessitated some such surgery under local anaesthesia (LA) especially those who lacked anti-hormonal bridging therapy option. We present a retrospective study comparing outcomes following breast conserving surgery (BCS) under LA and GA. Method(s): 31 patients under LA (April 2018-March 2022) were compared with 31 age-matched patients under GA during the same period. Main outcomes were length of hospital stay and rates of margin positivity, re-operation, and post-operative complications within 1 month (including wound infections, seromas needing >=3 aspirations). Statistical analysis (with R-4.2.2) used two-tailed test with significant p-value (<0.05). Result(s): Only 5 LA cases were performed in the 2 years prior to first UK Covid-19 lockdown (March 2020), whilst 26 cases were performed in the 2 years after. [Formula presented] Conclusion(s): The number of BCS cases under LA increased five-fold following Covid-19 pandemic. Outcomes under LA were no worse than under GA. BCS under LA can allow BCS in patients unfit for or unwilling to have GA, especially older patients. Dedicated lists for BCS under LA may reduce need for resources such as hospital beds and overnight stays in the current resource and financially constrained health-care system.Copyright © 2023

Delayed prosthetic seroma: a localized inflammatory response to COVID vaccination and infection?

We present a patient whom we believe developed a late abdominal mesh collection in response to COVID-19 mRNA vaccination booster and COVID-19 infection. A polypropylene mesh was placed during her right breast reconstruction operation 2 years ago where she underwent a right transverse abdominis rectus muscle (TRAM) free flap. She recovered uneventfully from this operation. This lady, though vaccinated, developed respiratory symptoms and tested positive for COVID-19 infection 3 days after her booster injection. She then noticed right-sided abdominal swelling 3 days after the onset of respiratory symptoms. She only presented 1 month later due to a 7-day history of pain at the site of abdominal swelling. A computed tomography scan confirmed the presence of a seroma, and she underwent ultrasound-guided percutaneous drainage. A COVID Antigen Rapid Test of the fluid returned positive, though the PCR swab returned negative. There have been no published reports of periprosthetic mesh seroma after COVID-19 vaccination or infection to date. We wanted to share our experience so that other surgeons may be aware of this potential presentation given the current ongoing pandemic. Level of evidence: Level V, risk/prognostic.

Late Seroma in Breast Implants: A Coronavirus Disease 2019 Phenomenon?

The coronavirus disease 2019 (COVID-19) pandemic has been challenging in all aspects of the medical field with new clinical presentations constantly arising. Plastic surgeons are not immune to this and need to be aware of their implications. There has been a recent report of late periprosthetic seroma (breast implant) as a clinical manifestation of COVID-19 infection. To our knowledge, this phenomenon has not been further reported. We present a 53-year-old immunocompromised lady who developed late seroma after COVID-19 infection. She eventually required explantation of the implant and is awaiting autologous reconstruction. It is likely that we will increasingly continue to see this phenomenon of implant complications as a result of COVID-19 infection and should be watchful, especially regarding potential immunocompromised patients.

Late seroma of the breast in association with COVID-19 infection: two case reports.

The SARS-CoV-2 pandemic is giving rise to a wide range of clinical manifestations, which can affect all organs and systems. Due to the enormous and constantly growing number of infected people, even the rarest complications will be observed in a very high number of patients. Late periprosthetic seroma of the breast has gained importance since the description of Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), but this entity is not the  only cause. Among the causes of non-BIA-ALCL late seroma, we can include those of mechanical origin and those of non-mechanical origin. Within the latter, the common denominator is the triggering of an aberrant immune reaction that generates an inflammatory exudate from the periprosthetic capsule that gives rise to the seroma. We present two cases of late breast seroma as a manifestation of SARS-CoV-2 infection. Level of evidence: Level V, diagnostic study.

Partial breast irradiation with IORT using Xoft®. Experience at Catalan Institute of Oncology

Purpose or Objective external beam whole breast irradiation (WBI) for low-risk early-stage breast cancer patients after breast conserving surgery. We present the experience at our center treating patients with PBI using an IORT technic with Xoft® Axxent® Electronic Brachytherapy (eBx®) System®. Materials and Methods Between April 2019 and August 2021, 44 patients diagnosed with low-risk early-stage breast cancer who met international criteria for PBI, received IORT in a single fraction of 20 Gy to the tumor bed after lumpectomy. Toxicities and follow up were prospectively registered. Results 3 of the 44 initial patients were discarded for IORT due to non-compliance with the minimum safety distance (<1 cm) between the applicator and the skin. Of the remaining patients, 32/41 patients (78%) received a PBI, while 9/41 (22%) required adjuvant WBI due to adverse prognostic factors identified on the definitive biopsy. The most frequent risk factor was close resection margins (<2mm), present in 8/9 patients (88,8%). Two patients additionally presented sentinel node involvement and in 1 case no axillary sample was obtained. The most used IORT applicator was the 3-4 cm balloon, with most likely filling volumes between 30cc and 40 cc. For all treatments, the mean filling volume of the applicator was 45 cc and there were no complications during the irradiation procedure. Surgical bed seroma was the most common acute effect, observed in 29/41 patients (70,7%), although only 8/29 (27,5%) required drainage. We observed wound dehiscence in 7/41 cases (17%), inflammatory complications requiring antibiotics in 9/41 cases (19,5%), and 4/41 cases of hematoma (9,7%). Regarding late toxicity, at the time of the analysis it was only assessable for 37 patients. We observed low rates of local grade I fibrosis (21,6%) and only 1 case of tumor bed G2 fibrosis. Hyperpigmentation G1 was observed in 8,1% of patients and 10,8% presented occasional mild local discomfort. With median follow-up of 17.14 months (range 4-29 months), no relapses were observed, but 1 patient died from covid-19 pneumonia. Conclusion Intra operative PBI with Xoft® Axxent® Electronic Brachytherapy (eBx®) System® is a feasible approach to treat low-risk early-stage breast cancer patients. Our preliminary results show that it presents advantages over conventional WBI allowing for less toxic and shortened treatment courses while maintaining good local tumor control.

Breast implant seroma: A SARS-CoV-2 mRNA vaccine side effect.

Fluid collection surrounding breast implants, called seroma, is a frequent issue that has diverse etiologies. We describe a 48-year-old woman with an acute onset of bilateral breast swelling occurring 5 years after aesthetic surgery and 10 days after a second SARS-CoV-2 mRNA vaccine dose. At breast ultrasound, we found an abundant bilateral peri-implant seroma. Our patient noticed symptom improvement 48 h after nonsteroidal anti-inflammatory drug treatment, complete disappearance of symptoms after 10 days with seroma disappearance documented by ultrasound. We hypothesized a breast implant seroma as post-SARS-CoV-2 mRNA vaccine side effect, as different other diagnosis had been excluded.