How has COVID-19 Affected Breast Reconstruction Options?
Surgical practice has been significantly impacted by the COVID-19 pandemic, with hospitals aiming to keep hospital beds free for emergency cases. In March, the NHS was advised to delay elective care. This meant that surgeries, screenings, and other treatments that were not deemed urgent were therefore postponed, with resources temporarily shifted to COVID-19 patients.
Breast cancer care has taken a frightening hit, with less screening exams, patient visits and surgical procedures. The strain on the NHS has caused hospitals to save protective personal equipment for urgent cases. These restrictions have caused breast reconstruction options to change significantly for women, causing extreme delays.
This piece will cover the following:
Find out how the pandemic has affected breast reconstruction options available.
The long-term impact of the pandemic on breast reconstruction.
Find out how you can get breast reconstruction surgery.
Frequently asked questions on breast reconstruction and the COVID-19 pandemic.
How have breast reconstruction options changed during the pandemic?
The actions and goals during the COVID-19 pandemic have consisted of the following:
- Cutting down the risk of infection for both patients and clinicians performing safe procedures
- Postponing non-urgent procedures and more advanced procedures
- Reducing postoperative consultations
- Postponing surgeries that require an overnight hospital stay where possible
Due to the demands of the pandemic, the Association of Breast Surgeons, UK recommended surgeons to offer mastectomy with no immediate breast reconstruction and to offer delayed reconstruction. Delayed reconstruction is reconstructive surgery that that may be performed several months or years after initial breast cancer surgery. The ASPS has also advised: “in general, plastic surgeons should err on the side of caution and delay reconstruction. Immediate autologous flap reconstruction for breast reconstruction is elective and should be delayed. If surgeries must be performed, we recommend strongly considering the utilisation of regional blocks to facilitate same-day discharge.”
In selected patients, immediate reconstruction with implants have become an option in some hospitals, however, this is not routinely recommended. Implant surgery requires a shorter hospital stay and ultimately less chance of contracting coronavirus. Implant procedures involve placing an implant under the chest wall muscle and skin. Immediate reconstruction after lumpectomy or mastectomy was made by risk balancing due to the possibility of complications, prolonging of the hospitalisation period and the need for additional surgeries (source).
Why is delayed breast reconstruction recommended?
Studies have shown that there is an increased complication rate in mastectomy with IBR when compared with mastectomy alone (source). Complications in the setting of breast reconstruction may often require an unplanned return to the OR for issues such as implant exposure or concern for flap ischemia. Delayed or immediate delayed surgery would, therefore, offer a safer approach. These delays have caused disappointment amongst patients expecting immediate reconstruction, increasing the risk of issues with self-image.
Dr Jonathan Bank, a board-certified plastic surgeon at New York Breast Reconstruction and Aesthetic (NYBRA) Plastic Surgery, says: “it has been very stressful and saddening giving news to patients that they couldn’t have breast reconstruction at this point; that’s probably been one of the most difficult components for us, but they are all understanding. They know that in the balance of risks and benefits, the risks of having surgery at this point are too great” (source).
Have routine appointments remained the same?
Some people have been advised not to come to the clinic because of the risk of the coronavirus itself, affecting routine appointments. This may happen if Doctors believed a patient is less likely to have cancer. This has also been the case due to a lack of resources caused by the outbreak. This could be due to staff being deployed or staff illness.
What to expect after the pandemic
Wait times for reconstruction both privately and in the NHS are expected to be delayed dramatically after the pandemic. Breast reconstruction will be in high demand for both women who were scheduled to have it earlier this year, and women who have recently decided to have it done. This will be particularly prominent for more complex surgeries, such as DIEP flap treatment, which has been unavailable in most hospitals and private centres. Waiting lists are therefore expected to get longer.
Wait times in the future will also depend on the number of resources and equipment available in hospital, which have likely been reduced due to the pandemic.
Am I a suitable candidate for breast reconstruction? You can read about what makes you a suitable candidate for breast reconstruction here.
How do I get breast reconstruction surgery?
Breast reconstruction can have a huge impact on your self-esteem and confidence, and you shouldn’t avoid talking to a professional about it. When making a decision about having breast reconstruction, you should talk to your surgeon and breast care nurse. They will advise you on the types of reconstruction that are most suitable for you.
You can read the NICE guidelines on having breast reconstruction here.
Finding a surgeon
TheBritish Association of Plastic, Reconstructive and Aesthetic Surgeons(BAPRAS) has a list of surgeons and hospitals with plastic surgery units.
Stephen McCulley is a specialist in breast reconstructive surgery, and he is one of the only surgeons in the country who offers patients surgery for breast cancer and reconstruction. You can read more about breast reconstruction and how Stephen McCulley can help you here.For more information, you can contact the clinic on 0115 962 4535.
Getting breast cancer treatment during COVID-19
Measures to reduce the spread of the coronavirus (COVID-19) and pressures on the NHS mean some breast clinic appointments are changing, but it’s still important to tell your GP about any new breast symptoms. Please do not hesitate to visit or call your local sector.
Frequently asked questions
What factors help doctors and patients choose different types of surgery?
The best reconstruction surgery suitable for you will depend on your overall health, lifestyle, the stage of your breast cancer, the size of your natural breast, and other personal factors.
Will my breast cancer surgery be postponed?
Urgent breast cancer surgery will not be delayed, however there is a high chance that your breast reconstruction surgery will be postponed. This depends on the surgery you are having, where you are having it and your personal situation.
Can I take someone with me to a breast cancer appointment?
If you are invited to attend a breast clinic, it is unlikely you will be able to take someone with you to the appointment. You should ring the hospital or private practice where you have the appointment to find out whether bringing other people is permitted.
What are the different types of breast reconstruction?
You can read our guide to the different types of breast reconstruction here.
How has breast cancer research been affected by coronavirus?
The pandemic has put a lot of lab-based research on hold. Many labs have been closed to protect scientists; however, researchers continue to be as productive with research as possible. You can read more about how breast cancer research has been impacted by the pandemic here.