COVID-19 and Cancer: Breast Reconstruction During Pandemic

For anyone facing a new cancer diagnosis or treatment choices in the midst of the COVID-19 pandemic, The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) is here to help and we want to answer your questions to optimize your cancer care and reduce anxiety about both your treatment and implications of COVID-19.

Cancer does not stop occurring for a pandemic, and the OSUCCC – James subspecialty cancer teams remain committed to performing critical, life-saving surgeries and the delivering medical treatments needed for each patient’s unique cancer. But COVID-19 has forced health care providers to make difficult decisions in all aspects of care to balance cancer control with the risk of COVID-19 infection for both patients and medical staff.

The process of breast reconstruction after a mastectomy is no different but psychosocial aspects of breast cancer care can present a unique set of important considerations for overall healing and quality of life.

For women considering a breast reconstruction surgery, thoughts on proceeding with the procedure during the pandemic can seem inconsistent and varied, says Clara Lee, MD, a plastic and reconstructive surgeon with The OSUCCC – James.

The American College of Surgeons, for instance, recommends stopping elective surgeries, but released a statement about breast reconstruction that was open-ended.

For patients, delaying a reconstruction surgery can seem nonsensical. If they’re already having a mastectomy, why not just include the reconstruction because it’s done during the same surgical period?

But with COVID-19 concerns swirling, Lee says the additional procedure adds two major considerations: a longer period of time spent in the operating room and additional postoperative visits after reconstruction. Both of these added steps can put patients and doctors at risk./

That’s why it’s important for doctors to be mindful of these surgeries. If the procedure will create the need for more in-person visits, it should be delayed. If a complication happens, it could add even more visits, another operation, or another hospital stay.

For these reasons, the OSUCCC – James stopped performing most immediate breast reconstruction surgeries during the pandemic stay at home order, unless there was a particular circumstance that requires an urgent procedure.

“Deciding whether a breast reconstruction surgery is urgent is not a black and white matter and different types of procedures come with different recommendations,” says Lee. “We want our patients to know that we are here as partners to help patients navigate these important decisions based on their specific situations.”

For instance, the revision of a reconstruction after a few years or a nipple reconstruction could wait without any negative effect on the patient, says Lee. Similarly, if a patient has had tissue expanders implanted post-mastectomy, there is no medical urgency to replace them with the permanent implants.

On the other end of the spectrum, if the procedure in question is a result of complications from a previous surgery, the procedure likely cannot wait. This could include issues with flap surgeries or issues with blood vessels, and these situations should proceed to ensure the health of the patient.

These example procedures may seem relatively straightforward, but the truth is that most surgeries related to breast cancer treatment will fall into a gray area between procedures that can wait and those that are urgent.

For these procedures, Lee says good communication between doctor and patient is paramount.

Many doctors are taking a proactive approach here, making direct contact with each patient who has an upcoming procedure to talk through options and get feedback from the patient. This can be an extremely beneficial way for both parties to get on the same page and establish priorities and next steps.

“As we continue to grapple with COVID-19, patient reactions have changed. In the early days of dealing with the virus, people were surprised at the idea of having surgeries postponed or rescheduled. But after dealing with the pandemic, patients have become more aware of what is happening and why there have been delays,” says Lee. “When it comes to breast reconstruction, specifically many of our patients understood that postponement could be the safest option for their health and the health of our doctors, and most people realize the importance of preserving personal protective equipment and other resources.”

Throughout this difficult process, Lee also notes that patients’ mental health should must be a priority.

“The current protective measures are necessary but we know there is an emotional impact of waiting to perform a breast reconstruction procedure. That is a very real and important part of the equation,” says Lee. “I encourage all patients to reach out and talk to their doctors. We can help explain the importance of waiting. We want to help, and we’re open to answering all of your questions.”