Effect of Coronavirus Disease 2019 Pandemic on Delivery of Breast Reconstructive Services and Outcomes.

[BACKGROUND] Delivery of immediate breast reconstruction (IBR) was severely restricted during the coronavirus disease 2019 (COVID-19) pandemic, with irreversible consequences for breast cancer survivors. This study aimed to determine the pandemic's effect on the provision of IBR services, quality of care delivered, and reconstructive outcomes.

[METHODS] For this multi-institutional, retrospective cohort study, data were obtained from all IBR cases during the study periods defined as "pre-COVID-19" (October 1, 2018, to March 14, 2020) and "COVID-19" (March 15, 2020, to October 31, 2021). Patient demographics, reconstructive strategy types, and oncological and surgical characteristics were analyzed. Safety and quality outcomes, including readmission, infection, seroma, mastectomy flap necrosis, and wait times were recorded.

[RESULTS] A cohort of 525 patients was included in this study. Patient and tumor characteristics were similar between the 2 study periods. There was a significantly lower odds of undergoing a single-stage alloplastic surgery (odds ratio [OR] = 0.40, 95% confidence interval [CI] = 0.17-0.94, = 0.0365) or autologous immediate reconstruction with a deep inferior epigastric perforator (DIEP) flap (OR = 0.42, 95% CI = 0.21-0.85, = 0.015) during the COVID-19 era, with a reciprocal 53% higher odds of 2-stage alloplastic surgery (OR = 1.53, 95% CI = 1.03-2.27, = 0.0359) during that time. Median wait time from first-stage to second-stage reconstruction was significantly shorter during COVID-19 ( = 0.0017). There were no differences in safety outcomes between the periods.

[CONCLUSIONS] Reconstructive strategies differed during the COVID-19 era of resource limitations with more 2-stage alloplastic procedures and fewer single-stage alloplastic and autologous immediate DIEP flap procedures.