Effects of COVID-19 on mastectomy and breast reconstruction rates: A national surgical sample

Abstract

Background: The COVID-19 pandemic profoundly impacted breast cancer treatment in 2020. Guidelines initially halted elective procedures, subsequently encouraging less invasive surgeries and restricting breast reconstruction options. We examined the effects of COVID-19 on oncologic breast surgery and reconstruction rates during the first year of the pandemic.

Methods: Using the National Surgical Quality Improvement Program, we performed an observational examination of female surgical breast cancer patients from 2017 to 2020. We analyzed annual rates of lumpectomy, mastectomy (unilateral/contralateral prophylactic/bilateral prophylactic), and breast reconstruction (alloplastic/autologous) and compared 2019 and 2020 reconstruction cohorts to evaluate the effect of COVID-19.

Results: From 2017 to 2020, 175 949 patients underwent lumpectomy or mastectomy with or without reconstruction. From 2019 to 2020, patient volume declined by 10.7%, unilateral mastectomy rates increased (70.5% to 71.9%, p = 0.003), and contralateral prophylactic mastectomy rates decreased. While overall reconstruction rates were unchanged, tissue expander reconstruction increased (64.0% to 68.4%, p < 0.001) and direct-to-implant and autologous reconstruction decreased. Outpatient alloplastic reconstruction increased (65.7% to 73.8%, p < 0.0001), and length of hospital stay decreased for all reconstruction patients (p < 0.0001).

Conclusions: In 2020, there was a nearly 11% decline in breast cancer surgeries, comparable mastectomy and reconstruction rates, increased use of outpatient alloplastic reconstruction, and significantly reduced in-hospital time across all reconstruction types.

Keywords: autologous; direct-to-implant; tissue expander.

Figure 1

Surgical breast patients per year who underwent lumpectomy or mastectomy for benign or malignant purposes (2017–2020).

Figure 2

Trends in mastectomy rates by type, immediate breast reconstruction rates, and autologous versus alloplastic (tissue expander, direct‐to‐implant) reconstruction rates (2017–2020). BPM, bilateral prophylactic mastectomy; CPM, contralateral prophylactic mastectomy; DTI, direct‐to‐implant; TE, tissue expander; UM, unilateral mastectomy.

Figure 3

Proportion of tissue expander, direct‐to‐implant, and autologous reconstruction (2019 vs. 2020).

Figure 4

Reconstruction method (TE vs. DTI vs. autologous) by mastectomy type (2019 vs. 2020). DTI, direct‐to‐implant; TE, tissue expander.