Microsurgical Autologous Breast Reconstruction in the Midst of a Pandemic – A Single-unit COVID-19 experience

Ho, Weiguang; Köhler, Guido; Haywood, Richard; Rosich-Medina, Anais; Masud, Dhalia

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 3/6/2020. We aim 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 retrospective reviewed prospectively collected data in the “pre-COVID” (3/6/2019-31/12/2019) and “post-COVID” period (3/6/2020-31/12/2020). Patient demographics included age, BMI, co-morbidities, ASA grade and smoking status. Surgical factors included neoadjuvant chemotherapy, previous chest wall radiotherapy, unilateral or bilateral reconstruction, reconstruction timing, number of pedicles, contralateral symmetrisisation and other procedures. Dependent 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 were recorded and analysed. RESULTS: Fewer DIEP flaps were performed in the “post-COVID” period (45 vs 29). There was no significant difference in mastectomy resection weight, but flap weight was significantly increased. There was no significant difference in ischaemic time. The postoperative length of stay was significantly reduced. There was no significant difference 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. CONCLUSION: Although fewer cases were performed, autologous breast reconstruction was safely delivered throughout the COVID-19 pandemic in the first wave without affecting training.