Guidelines for Breast Surgery During the COVID-19 Pandemic

The COVID-19 pandemic descended upon us with unprecedented speed. With it came rapid changes in information that affected how we handled cases hour-to-hour as we worked with the greater medical community to determine and develop new best practices. Individual medical societies began to release recommendations for breast surgery during the pandemic as early as March. This quickly altered treatment for some recently diagnosed breast cancer patients. Some patients previously scheduled for mastectomies were treated with lumpectomies, and surgical treatments were delayed using hormonal therapy when possible.

On April 13th, the American Society of Breast Surgeons (ASBrS), National Comprehensive Cancer Network (NCCN), Commission on Cancer (CoC), and the American College of Radiology (ACR) released a joint statement that established guidelines for how breast cancer patients should be treated during the COVID-19 Pandemic.

The statement placed breast cancer patients in three levels based on the severity of their diagnosis:

Level A: patients with immediately life threatening or symptomatic, requiring urgent treatment
Examples: Life threatening breast infection or bleeding

Level B: patients who should start treatment before the pandemic is over
Examples: Triple negative and HER2 positive patients, patients finishing neoadjuvant chemotherapy, patients with positive axillary lymph nodes

Level C: patients who can safely defer treatment until the pandemic is over
Examples: DCIS, stage 1 cancers with negative axillary lymph nodes, prophylactic surgeries (high risk/genetic mutations), benign disease

The full statement and guidelines are available here.

The American Society of Plastic Surgeons also recommended that autologous (tissue flap) reconstructions be delayed. Tissue expander and implant reconstructions can proceed depending on hospital resources.

These guidelines aim to identify breast cancer patients who require urgent care and those who can safely delay their treatment. Like all guidelines, they are designed to be used in conjunction with relevant supporting information. Physicians and hospitals will consider their local COVID-19 infection rates and available hospital resources to determine how to proceed safely.

Over the last few weeks, nurses, physicians, and other front line workers have done an incredible job fighting this virus. With the help of social distancing, they are forcefully bending the curve. Thanks to their work, there seems to be a glimmer of light at the end of the tunnel. We cannot immediately return to normalcy, and treatment will continue to be prioritized based on severity of the diagnosis, but we are making critical, forward progress.

In the meantime, knowledge is not only power, it is one of the best ways to alleviate anxiety. New York Breast Reconstruction and Aesthetic Plastic Surgery has remained open throughout this crisis and continues to care for breast cancer patients. We are available to existing or new patients with questions or concerns about upcoming or previous breast reconstruction. Contact our office at 516-498-8400 to set up a telemedicine consultation. Stay strong. Be smart. Stay safe.


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