The impact of COVID-19 pandemic on breast surgery in Italy: a multi-centric retrospective observational study

Abstract

COVID-19 pandemic had an impact on surgical activities. The aim of this multi-centric, retrospective study was to evaluate the impact of the COVID-19 pandemic on breast surgery. The patients who operated during the pre-pandemic year 2019 were compared to those operated in 2020. Fourteen Breast Care Units provided data on breast surgical procedures performed in 2020 and 2019: total number of breast-conserving surgery (BCS), number of 1st level oncoplastic breast surgery (OBS), number of 2nd level OBS; total number of mastectomies, mastectomies without reconstruction, mastectomies with a tissue expander, mastectomies with direct to implant (DTI) reconstruction, mastectomies with immediate flap reconstruction; total number of delayed reconstructions, number of expanders to implant reconstructions, number of delayed flap reconstructions. Overall 20.684 patients were included: 10.850 (52.5%) operated during 2019, and 9.834 (47.5%) during 2020. The overall number of breast oncologic surgical procedures in all centers in 2020 was 8.509, compared to 9.383 in 2019 (- 9%). BCS decreased by 744 cases (- 13%), the overall number of mastectomies decreased by 130 cases (- 3.5%); mastectomy-BCS ratio was 39-61% in 2019, and 42-58% in 2020. Regarding immediate reconstructive procedures mastectomies with DTI reconstruction increased by 166 cases (+ 15%) and mastectomies with immediate expander reconstruction decreased by 297 cases (- 20%). Breast-delayed reconstructive procedures in all centers in 2020 were 142 less than in 2019 (- 10%). The outburst of the COVID-19 pandemic in 2020 determined an implemented number of mastectomies compared to BCS, an implemented number of immediate breast reconstructions, mainly DTI, and a reduction of expander reconstruction.

Keywords: Breast surgery; COVID-19; DTI reconstruction; Mastestomy; Pandemic.

Fig. 1

Map of Italy showing the location of the 14 Breast Care Units, classified in the table and numbered according to the number of breast surgical procedures performed in the pre-pandemic year 2019: 1 IEO-Milano, 2 Policlinico Gemelli- Roma, 3 AUSL della Romagna, 4 Città della Salute-Torino, 5 Pisa, 6 ASST Sette Laghi, Varese, 7 ASUFC, Udine, 8 Campus Biomedico, Roma, 9 IRCCS- Policlinico San Matteo- Pavia, 10 Ospedale Sassari, 11 Ospedale Fatebenefratelli- Roma, 12 Ospedale San Martino—Genova, 13 Policlinico Bari, 14 Policlinico Palermo. Collected data are analyzed dividing the 14 Breast Care Units into 3 subgroups according to the geographic location: Lombardy (in stripes on the map); Northern Italy except Lombardy (above the dashed line); Central and Southern Italy (below the dashed line)