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    No.55: Ask the Expert: Breast Cancer Reconstruction & COVID-19

    Dana Donofree is joined by Dr. Brannon Claytor to answer your questions about the recent American Society of Plastic Surgery (ASPS) news that some surgeries are being delayed due to the COVID-19 pandemic. Dr. Claytor is the Chief of Plastic Surgery at MainLine Health and owner of his private practice, Claytor/Noone Plastic Surgery.

    Here's what the ASPS recommends:

    a) Physicians should consider including as part of his/her informed consent process the issue of performing reconstructive surgery in light of the COVID-19 pandemic and the potential consequences to the patient and others as this may have in regards to the potential for increased exposure as a result of the procedure itself, as well as the potential risks and complications that may occur postoperatively.

    b) In general, plastic surgeons should err on the side of caution and delay reconstruction

    c) Immediate autologous flap reconstruction for breast reconstruction is elective and should be delayed (This does not include wound coverage issues of the chest/breast.)

    d) 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. The decision should take into account the likelihood of complication, the age and comorbidities of the patient, the likelihood that reconstruction would lead to utilizing a hospital bed, the length of surgery and resources utilized, as well as local-regional and individual institutional factors such as the availability of healthcare resources and anticipated availability of resources in the post-operative period.

    e) If Oncoplastic reconstruction is a consideration, it should also be evaluated on a case by case basis, depending on the complexity of the reconstruction and the likelihood of complication, the patient’s risk (age and comorbidities), utilization of resources, length of surgery, likelihood of admission, and local regional factors listed above.

    f) Consider only addressing the cancer side and avoid prolonged surgery by avoiding concurrent contralateral balancing procedures.

    g) If surgeries must be performed, we recommend strongly considering the utilization of regional blocks to facilitate same-day discharge. Also, minimizing the number of people in the operating room to decrease the risk of exposure as well as decrease PPE use.

    We know that this news may come as a blow to those newly diagnosed, awaiting planned mastectomies and reconstructive surgeries, breast revisions, or preventative mastectomies, and we want you to know we are here for you during this time, and during your future recovery. 

    It is 100% OK to wait on your reconstructive procedures, it may actually be more common than you may realize. Often times reconstruction is delayed for patients undergoing radiation therapy to allow time for healing from the treatment and not damaging the reconstruction. There are also many breast cancer patients that initially decided to remain flat and later reconstruct for many reasons, timing, finances, family, or personal decisions.

    Beth Fairchild Breast Reconstruction Options
    Meet Beth Fairchild, an advocate for Stage IV Metastatic Breast Cancer and former President of METAvivor.org, our beneficiary of our annual New York Fashion Week fundraiser. Beth says, "For all of you out there who need to hear this: breast reconstruction after cancer is a shared decision and a very important one. After I had breast reconstruction with Natrelle INSPIRA®, a lot of women reached out to me, and the one thing I always tell them is that you and your surgeon are a team! I felt like Dr. Blanton listened to my needs and addressed all of my concerns going into this process. It’s so important to clearly communicate your wants and needs to your surgeon so that he or she can help determine what’s best for you and your body. If you’re considering breast reconstruction, please be sure to find a surgeon you’re comfortable with and who works WITH you, not for you." She shared this post on her Instagram profile after her decision to reconstruct after living years as fearless flat advocate. 

    We love what she says about your plastic surgeon being on your team. They are helping to make these incredibly tough, but necessary, decisions in a very difficult time. If you have any other questions after watching Dana Donofree and Dr. Brannon Claytor discuss this hot topic, please leave them below in the comments and we will work to get you the answers you need. 

    Please always feel free to email us at CS@AnaOno.com with any questions you may have about how to recover from your upcoming mastectomy or reconstructive surgery, and we are here to support you through it.