Day case partial breast reconstructions with chest wall perforator flaps before and during the COVID-19 pandemic.

Abstract

Background: Partial breast reconstruction with chest wall perforator flap (CWPF) offers patient the option of breast conserving surgery (BCS) over a mastectomy in selected cases Mastectomy with or without reconstruction has its implications on woman’s physical, sexual, psychosocial and mental wellbeing Furthermore, it has been shown that in early stage breast cancer disease, BCS followed by adjuvant radiotherapy has equivalent if not better overall survival outcome compared to mastectomy without adjuvant radiotherapy Here we aim to present our outcome of CWPFs before and during the COVID 19 pandemic Materials and Methods: This is a retrospective observational cohort outcome study of patients undergoing a single stage immediate CWPFs performed before and during COVID 19 The study analysis included patients underwent CWPF between 1 July 2015 and 9 March 2020 (before COVID 19), and between 11 March 2020 and 31 July 2020 (during COVID 19) The primary outcome was the length of stay, <23 hours stay Secondary outcome was rate of re-excision margin(s) or mastectomy and surgical complications Results: Before COVID 19 over the period of 44 months, 93 patients underwent CWPF, 87 patients (94%) where successfully discharged on the same day of surgery or <23 hours stay Re-excision margin(s) rate was 9,7% and non-required completion mastectomy Three patients (3%) had unplanned return to theatre: 2 for evacuation of haematoma and 1 for repair of wound break down Eleven patients (12%) had minor complications treated conservatively without hospital admissions;these complications include delayed wound healing, infection, seroma, and fat necrosis During the pandemic, over the period of 5 months, 4 patients underwent CWPF All patients were discharged on the same day of surgery or < 23 hours stay None of the patients required re-excision margin or completion mastectomy One had post-op seroma requiring drainage in the outpatient setting Conclusions: This model where CWPF for partial breast reconstruction is performed as a day case procedure in the immediate single stage setting has shown to be successful and effective before and during COVID 19 in our cohort of patients In the era of post COVID 19, CWPF for partial reconstructions is feasible as a day case procedure and should be considered when resuming oncoplastic & reconstructive breast surgery service