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. 2023 Nov;202(2):257-265.
doi: 10.1007/s10549-023-07064-1. Epub 2023 Jul 29.

COVID-associated complications after reconstructive breast surgery: a retrospective cohort study

J M Bubberman  1   2 , J Claessen  3 , M M W Feijen  4 , M A J Meesters-Caberg  4 , S M J Van Kuijk  5 , R R W J Van der Hulst  1   2 , S M H Tuinder  6   7
Affiliations

COVID-associated complications after reconstructive breast surgery: a retrospective cohort study

J M Bubberman et al. Breast Cancer Res Treat. 2023 Nov.

Abstract

Purpose: The COVID pandemic significantly influenced reconstructive breast surgery regimens. Many surgeries were cancelled or postponed. COVID entails not only respiratory, but also coagulative symptoms. It, therefore, potentially increases the risk of postoperative complications. The incidence of perioperative COVID infection and its influence on postoperative recovery after reconstructive breast surgery is still unknown.

Methods: This dual center retrospective cohort study included patients that underwent reconstructive breast surgery between March 2020 and July 2021. Post-mastectomy autologous or implant-based breast reconstruction (ABR; IBR), as well as post-lumpectomy oncoplastic partial breast reconstruction (PBR) were eligible. Patient data were extracted from electronic medical records. Data regarding COVID-19 infection was collected through a questionnaire. The primary outcome was complication rate.

Results: The ABR, IBR and PBR groups consisted of 113 (12 COVID-positive), 41 (2 COVID-positive) and 113 (10 COVID-positive) patients. In the ABR and PBR groups, postoperative complications occurred significantly more often in patients with perioperative COVID-infection. Especially impaired wound healing occurred significantly more often in the ABR and PBR breasts, but also at the donor site of ABR patients with perioperative COVID.

Conclusion: Perioperative COVID-infection increases susceptibility to complicated wound healing after reconstructive breast surgery. A possible explanation lies in the dysregulation of haemostasis by the virus, and its direct effects on microvasculature. A hypercoagulable state results. We recommend to postpone elective breast surgery for 4-6 weeks after COVID-19 infection. Also, precautionary measures remain important to minimize the risk of perioperative COVID-19 infection.

Keywords: Breast cancer; Breast reconstruction; COVID-19; Postoperative complications.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Surgical details. DIEP deep inferior epigastric perforator; DUG diagonal upper gracilis; LAP lumbar artery perforator; LD latissimus Dorsi; LTP lateral thigh perforator; SGAP superior gluteal artery perforator; ScGAP septocutaneous gluteal artery perforator; SHAEP stacked hemi-abdominal extended perforator. ADM acellular dermal matrix. LICAP lateral intercostal artery perforator; AICAP anterior intercostal artery perforator; TDAP thoracodorsal artery perforator
Fig. 2
Fig. 2
Postoperative complications in the ABR group (A), and PBR group (B)
See this image and copyright information in PMC

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