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COVID-19 microsurgical breast reconstruction national practise survey: A survey of BAPRAS members and proposal of COVID-19 specific perioperative and ERAS pathways

Published:October 24, 2020DOI:https://doi.org/10.1016/j.bjps.2020.10.015
      Breast reconstruction is one of the largest subspecialties within plastic surgery. The ‘Clinical Guide to Surgical Prioritisation During the Coronavirus Pandemic’ published by the Federation of Surgical specialty Associations during the COVID-19 pandemic defines breast reconstruction as a non-urgent priority 4 (surgery that can be delayed > 3 months) procedure. As such, breast reconstructive services have largely ceased. Recovery strategies have now been implemented to mitigate COVID-19 risk with both British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) and the Association of Breast Surgery producing guidance on recommencing breast reconstruction services.
      British Association of Plastic
      Reconstructive and aesthetic surgeons breast reconstruction working group.
      British Association of Plastic
      Reconstructive and aesthetic surgeons breast reconstruction working group.

      Association of Breast Surgery. ABS support for new BAPRAS guidance on immediate breast reconstruction. Available at URL: http://www.bapras.org.uk/docs/default-source/default-document-library/abs-bapras-support-doc.pdf?sfvrsn=2 (accessed July 27th 2020).

      These guidelines advocate breast reconstruction, whilst highlighting existing issues to be addressed, challenges and potential opportunities. However practical advice on adapting referral pathways or enhanced recovery after surgery (ERAS) pathways during COVID-19 have not been addressed. Whilst existing ERAS pathways have been shown to reduce complication rates and shorten hospital stay for patients, they clearly need modification during the recovery from the pandemic but also in light of a potential second wave.
      • Temple-Oberle C.
      • Shea-Budgell M.A.
      • Tan M.
      • Semple J.L.
      • et al.
      Consensus review of optimal perioperative care in breast reconstruction: enhanced recovery after surgery (ERAS) society recommendations.
      ,
      • Sindali K.
      • Harries V.
      • Borges A.
      • et al.
      Improved patient outcomes using the enhanced recovery pathway in breast microsurgical reconstruction: a UK experience.

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      References

        • British Association of Plastic
        Reconstructive and aesthetic surgeons breast reconstruction working group.
        Restarting Breast Reconstruction Services - Immediate Reconstruction, 2020 (Available at URL: http://www.bapras.org.uk/docs/default-source/default-document-library/restarting-breast-recon-pathways.pdf?sfvrsn=2 accessed July 27th)
        • British Association of Plastic
        Reconstructive and aesthetic surgeons breast reconstruction working group.
        Restarting Breast Reconstruction Services - Delayed Reconstruction, 2020 (Available at URL: http://www.bapras.org.uk/docs/default-source/default-document-library/covid-breast-reconstruction-delayed-recon.pdf?sfvrsn=2 accessed July 27th)
      1. Association of Breast Surgery. ABS support for new BAPRAS guidance on immediate breast reconstruction. Available at URL: http://www.bapras.org.uk/docs/default-source/default-document-library/abs-bapras-support-doc.pdf?sfvrsn=2 (accessed July 27th 2020).

        • Temple-Oberle C.
        • Shea-Budgell M.A.
        • Tan M.
        • Semple J.L.
        • et al.
        Consensus review of optimal perioperative care in breast reconstruction: enhanced recovery after surgery (ERAS) society recommendations.
        Plast Reconstr Surg. 2017; 139 (1056e–1071e)
        • Sindali K.
        • Harries V.
        • Borges A.
        • et al.
        Improved patient outcomes using the enhanced recovery pathway in breast microsurgical reconstruction: a UK experience.
        JPRAS Open. 2019; 19: 24-34