BACKGROUND: The majority of two-stage prepectoral breast reconstruction has been described utilizing acellular dermal matrix (ADM). Although reports of prepectoral breast reconstruction without ADM exist, there is a paucity of comparative studies. METHODS: A single-institution retrospective review was performed of consecutive patients undergoing immediate prepectoral two-stage breast reconstruction with tissue expanders from 2017 to 2019. Short-term reconstructive and aesthetic complications were compared between cases that utilized ADM for support and those that did not. RESULTS: In total, 76 cases (51 patients) were identified, of which 35 cases utilized ADM and 41 did not. Risk factors and demographics were similar between the two cohorts with the exception of body mass index, which was higher in the ADM cohort (29.3 versus 25.4, P = 0.011). Average follow-up length was also longer in patients who received ADM (20.3 versus 12.3 months, P < 0.001). Intraoperative expander fill was higher in patients who did not receive ADM (296.8 cm3 versus 151.4 cm3, P < 0.001) though final implant size was comparable in both cohorts (P = 0.584). There was no significant difference in the rate of any complication between the ADM and no ADM cohorts (25.7% versus 17.1%, respectively P = 0.357), including major mastectomy flap necrosis (P = 0.245), major infection (P = 1.000), seroma (P = 0.620), expander explantation (P = 1.000), capsular contracture (P = 1.000), implant dystopia (P = 1.000), and rippling (P = 0.362). CONCLUSIONS: Immediate two-stage prepectoral breast reconstruction with tissue expanders has comparable rates of short-term complications with or without ADM support. Safety of prepectoral expander placement without ADM may warrant more selective ADM use in these cases.

UNLABELLED: Ischemic complications after immediate breast reconstruction have devastating consequences; however, individual risk assessment remains challenging. We seek to develop an intraoperative assessment tool to assist in estimating risk of ischemic complications in immediate breast reconstruction. METHODS: Patients undergoing immediate breast reconstruction were prospectively identified and evaluated with an intraoperative mastectomy flap ischemia risk assessment tool consisting of 8 binary questions. Breast measurements and patient demographics were recorded. Reconstructions were then prospectively evaluated postoperatively for ischemic complications. Outcomes were analyzed with significance set at P values <0.05. RESULTS: Thirty-one patients underwent 45 immediate breast reconstruction. The majority of reconstructions were tissue expander based (64.4%) following therapeutic (62.2%) skin-sparing (93.3%) mastectomies. Average follow-up was 11.16 months. Sixteen reconstructions (35.6%) experienced an ischemic complication. The average total mastectomy flap ischemic risk score was 4.29. The correlation value of higher scores with increasing ischemic complications was 0.65. Reconstructions with scores greater than 5 had significantly higher rates of ischemic complications (P = 0.0025). Reconstructions with a score of >6 and >7 also had significantly higher rates of ischemic complications (P < 0.0001, each). The sensitivity and specificity of intraoperative mastectomy flap compromise were 81.25% and 62.07%. CONCLUSIONS: Ischemic complications after immediate breast reconstruction were positively correlated with higher scores using a clinical intraoperative mastectomy flap ischemia risk assessment tool. Scores greater than 5 seem to be a threshold value at which ischemic complications are significantly greater. This simple, easy-to-implement intraoperative tool may assist plastic surgeons in assessing risk and optimizing outcomes in immediate breast reconstruction.

INTRODUCTION: The coronavirus disease-19 (COVID-19) pandemic dramatically changed the delivery of breast cancer care. The objective of this study was to quantify the effect of the pandemic on breast cancer screening, treatment, and reconstruction at a single institution in New York City. METHODS: A retrospective chart review was conducted to determine the number of mammograms, lumpectomies, mastectomies, and breast reconstruction operations performed between January 1, 2019 and June 30, 2021. Outcomes analyzed included changes in mammography, oncologic surgery, and breast reconstruction surgery volume before, during and after the start of the pandemic. RESULTS: Mammography volume declined by 11% in March-May of 2020. Oncologic breast surgeries and reconstructive surgeries similarly declined by 6.8% and 11%, respectively, in 2020 compared with 2019, reaching their lowest levels in April 2020. The volume of all procedures increased during the summer of 2020. Mammography volumes in June and July 2020 were found to be at pre-COVID levels, and in October-December 2020 were 15% higher than in 2019. Oncologic breast surgeries saw a similar rebound in May 2020, with 24.6% more cases performed compared with May 2019. Breast reconstruction volumes increased, though changes in the types of reconstruction were noted. Oncoplastic closures were more common during the pandemic, while two-stage implant reconstruction and immediate autologous reconstruction decreased by 27% and 43%, respectively. All procedures are on track to increase in volume in 2021 compared to that in 2020. CONCLUSION: The COVID-19 pandemic reduced the volume of breast cancer surveillance, surgical treatment, and reconstruction procedures. While it is reassuring that volumes have rebounded in 2021, efforts must be made to emphasize screening and treatment procedures in the face of subsequent surges, such as that recently attributable to the Delta and Omicron variants.