These are extraordinary times.
For those women recently diagnosed with breast cancer, this – coronavirus, covid-19, shelter in place, social distancing, quarantine- has added incredible stress onto an already stressful situation. Please read my blogs on ways to help keep you healthy during this time.
For plastic surgeons, there is the question of what is elective surgery? Is cancer surgery elective? urgent? semi urgent? If you do the mastectomy can you do a breast reconstruction too?
The ASPS is our national organization for Board Certified Plastic Surgeons. They sent out a note to all plastic surgeons, which I will repeat the tenets of here, “Covid-19 and Breast Reconstruction- ASPS statement”. This was drafted by a working group convened to develop guidelines during this time.
This applies to surgeons all over the US, in private practice and academic settings, who do implant based or autologous (free flap, TRAM) breast reconstructions. This means every plastic surgeon. Everywhere.
- DELAYED RECONSTRUCTION & REVISIONS. These are planned secondary surgeries. They are elective and should be postponed until “the system in your area can accommodate elective surgery as deemed safe for patients.”
- IMMEDIATE RECONSTRUCTION. Reconstructive procedures “still utilize additional resources and increase the risk of complications and depending on the procedure, increase the risk of needing to use a hospital bed.”
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- They require PPE
- They require office visits (to fill tissue expander or deal with complciations)
- They increase risk of exposure
- Local regional shortages may be or may become critical
- Patients need to understand their risk for exposure due to procedure or other risk/complications postoperatively.
- Err on the side of caution and delay reconstruction
- Immediate autologous flap reconstruction should be delayed. (unless needed for wound coverage issues of the chest)
- Immediate tissue expander or immediate implant can be evaluated on a case by case basis. This should look at the likelihood of complications (age, comorbidities, likelihood of needing a hospital bed, length or surgery)
- Consider only addressing the cancer side to avoid prolonged surgery. Avoid concurrent contralateral balancing surgeries. (Many times we do a lift, reduction, or implant on the other breast to increase breast symmetry after breast cancer reconstruction.)
- Minimize number of people in the OR to decrease risk of exposure and decrease PPE use.
- Same day discharge for surgeries done.
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Bottom line?
Many hospitals are evaluating elective surgeries by level of urgency (rating them on what the likelihood of increased morbidity or mortality is if the procedure is delayed 14 days or 30 days). Truly elective surgeries can be safely postponed for 30 days with no issues.
Breast cancer surgery “urgency” will vary based on many patient factors, like the size and aggressiveness of your tumor.
The best thing you can do right now is stay as healthy as you can to prepare you for surgery. Read my blogs on coronavirus HERE.
My heart is with you. Breast cancer is scary enough on its own. You didn’t need this extra layer of stress.