Guidelines for breast reconstruction during the COVID‐19 pandemic: Are we considering enough evidence?

Nishant Ganesh Kumar MD Theodore A. Kung MD First published: 13 August 2020

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In light of the COVID‐19 pandemic, on March 24, the American Society of Plastic Surgeons (ASPS) issued guidelines on how to triage breast reconstruction. At the time of this commentary, the current guidelines from the ASPS recommend “caution and [to] delay reconstruction” and that because it is elective, “immediate autologous flap reconstruction for breast reconstruction…should be delayed.” It also recommends that “while erring on the side of delayed reconstruction, immediate tissue expander or direct to implant reconstruction can be evaluated on a case‐by‐case basis.” These guidelines echo statements issued by the American College of Surgeons (ACS) that “autologous breast reconstruction should be deferred,” and by the Society of Surgical Oncology (SSO) that breast reconstruction “should enable recovery as an outpatient.”

We believe that both implant‐based and autologous breast reconstruction are important for women after mastectomy and that the ultimate decision regarding which approach to pursue should be made between the patient and plastic surgeon. In the setting of the COVID‐19 pandemic, it is the plastic surgeon's responsibility to provide breast reconstruction without placing undue burden on the health care system or risk to the patient. While the current national guidelines are helpful, they appear to unfairly restrict autologous reconstruction without bearing in mind the implications of potential complications associated with implant‐based reconstruction, such as hospital readmissions for infection, additional surgery, and in‐person clinic visits.

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Jasmine Walter

Content Editor, Mark Allen Group

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