Background:. Current methods for assessing outcomes after bilateral breast reduction (BBR) include traditional metrics (length of stay, morbidity, and mortality), and more recently, patient-reported outcome measures. These can be limited by subjectivity and poor granularity. Postoperative physical activity collected from patients’ smartphones has since been validated as an objective measure of recovery. This study aims to investigate recovery after BBR using this novel outcome measure. Methods:. A single-center, retrospective cohort analysis was conducted of patients who had undergone BBR surgery at Imperial College NHS Healthcare Trust from August 2021 to February 2024. A smartphone application was used to retrospectively gather physical activity data from patients covering 1 month preoperatively to 6 months postoperatively. Data were analyzed to provide the time taken to return to 90% of preoperative activity levels, as well as daily activity patterns. Results:. Fifty-six patients undergoing breast reduction were recruited. Postoperative recovery data were used to plot novel recovery curves, whereby the average return to baseline activity was 33.5 days. The only patient or surgical factor found to be a predictor of recovery was the weight of tissue removed, correlating negatively with activity levels in the first 2 weeks (P = 0.027). Daily activity patterns revealed clear changes in behavior over time, providing novel insight into return to work. Conclusions:. Activity data from patients’ smartphones enhance our ability to investigate postoperative recovery with unique detail. Integration of these data alongside traditional measures could help to better inform patients and clinicians regarding recovery, outcomes, and funding decisions in this cohort.

Introduction The demand for breast reconstruction has increased owing to the established benefits for patients. Given the long-term survivorship, objective data are vital to aid patients in making treatment decisions. This prospective longitudinal observational study was carried out to objectively quantify the impact of simple mastectomy (Mx), implant-based reconstruction (IBR) and deep inferior epigastric perforator (DIEP) on upper limb (UL) activity using wearable activity monitors (WAMs). Methods Forty-eight consecutive patients who underwent breast and reconstructive surgery were identified from operating schedules. Recruited participants were invited to wear WAMs on both wrists for an average of 3 days preoperatively, for 2 weeks post-operatively and more than 6 months post-operatively. Results A significantly greater reduction in gross physical activity as a percentage of preoperative activity was observed in DIEP compared with Mx and IBR patients across week 1 (median: 40% versus 62% versus 62%; p<0.001) and week 2 (median: 60% versus 77% versus 84%; p<0.001). In the long-term follow-up, the average activity had reached or exceeded their baseline levels for all operative procedures, Mx=114%, IBR=98% and DIEP=103%. DIEP was an independent predictor of recovery in weeks 1 (F=4.796, p=0.043) and 2 (F=7.306, p=0.015). Conclusion Despite DIEP patients having the lowest UL activity level in the acute post-operative period when compared with Mx and IBR patients, average activity levels returned to baseline in the long-term for all procedures. Objective monitoring of recovery using WAMs can support the development of a personalised rehabilitation programme for those at risk of developing complications.

Aims: To understand variation in the cost of autologous breast reconstruction in the UK, including identifying key areas of cost variability, differences between and within units and the impact of enhanced recovery protocols (ERAS).Methods: A micro-costing study was designed based on the responses to a national survey of clinical preferences completed by the majority of plastic surgeons and anaesthetists involved in the UK. Detailed costs were estimated from macro elements such as ward and theatre running costs, down to that of surgical meshes, anaesthetic drugs and flap monitoring devices.Results: The largest variation in cost arose from postoperative location and length of stay, preoperative imaging and flap monitoring strategies. Plastic surgeon costs varied from 1282 pound to 3141 pound, whereas anaesthetic costs were between 32 pound and 151 pound (not including salary). Estimated cost variation within units was up to 893 pound per case. Units with ERAS had significantly lower total costs than those without (p < 0.05).Conclusion: This study reveals significant cost variation in breast reconstruction in the UK based on clinician preferences. Many areas of practice driving this variation lack strong evidence of any clinical advantage. The total cost of a deep inferior epigastric perforator in the majority, if not all units, likely surpasses the national tariff for reimbursement, particularly when considering additional resource demand for immediate and bilateral breast reconstruction, as well as future symmetrisation procedures. Whilst units should look to streamline costs through ERAS, there should also be a realistic tariff that promotes excellent care.(c) 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd.

PURPOSEThis work aimed to investigate the validity of Wearable Activity Monitors (WAMs) as an objective tool to measure the return towards normal functional mobility following abdominal wall surgery. This was achieved by quantifying and comparing pre- and postoperative physical activity (PA).METHODSA multi-centre, prospective, observational cohort study was designed. Patients undergoing abdominal wall surgery were assessed for eligibility and consented for study participation. Participants were asked to wear a WAM on the wrist of their dominant hand (AX3, Axivity) at least 48hours pre-operatively, for up to 2 weeks post-op, and then again after 6 months postop for 48hours.RESULTSA cohort of 20 patients were recruited in this validation study with a mean age of 47.3 ± 13.0 years. Post operation, the percentage median PA (±IQR) dropped to 32.6% (20.1), while on day 14, PA had reached 64.6% (22.7) of the preoperative value providing construct validity. Activity levels at > 6 months postop increased by 16.4% on average when compared to baseline preoperative physical activity, p=0.046.CONCLUSIONThis study demonstrates that WAMs are valid markers of postoperative recovery following abdominal wall surgery. This was achieved by quantifying the reduction in PA post-operation, which has not been previously shown. In addition, this study suggests that abdominal wall surgery improves patient quality of life via increased functional mobility at 6 months postop. In the future, this technology could be used to identify the patient and surgical factors that are predictors of outcome following abdominal wall surgery.

Androgenetic alopecia is the most common form of hair loss. Surgical treatment options include autologous and synthetic hair transplantation. Synthetic hair fibres can overcome the challenges of poor hair quality and density however there are reports of severe cutaneous complications following their use. We report a case of an advanced squamous cell carcinoma (SCC) of the scalp in an adult male patient following chronic artificial hair transplants. The fungating mass eroded the inner cortex of the left parietal bone without intra-cranial extension on CT. Indeterminate lymph nodes in the parotid gland and level III of the left neck were identified on CT and MRI. Resection of the artificial hair fibres and SCC with a craniectomy, total parotidectomy with facial nerve preservation and upper neck dissection were performed. There was extensive dural involvement not detected on pre-operative imaging, which involved the superior sagittal sinus and was unresectable. The dural disease was fulgurated. The defect was reconstructed with a titanium plate and DIEP flap. Final histopathology showed a moderately differentiated pT4a N0 M0 SCC. The patient received adjuvant proton beam therapy and at 18 months post-operatively is recurrence free. Development of scalp SCC following synthetic hair transplantation has been described, although a clear causation has not been defined. Clinicians should be aware of this presentation and aim to achieve an early diagnosis, timely referral to an appropriate specialist and prompt management.

Introduction: Autologous free-flap breast reconstruction accounts for 30% of reconstruction following mastectomy. However there is no consensus regarding immediate post-operative monitoring protocols. We report the time periods and salvage rates for free-flaps which were returned-to-theatre at a high-volume practice. Materials and Methods: The prospectively collected electronic records for patients undergoing breast free-flap reconstruction between January 2015 and August 2019 were reviewed retrospectively. All free-flaps were reviewed by nurses using the standardised hospital protocol until discharge. Primary end-points evaluated include free-flaps which were returned-to-theatre for full free-flap loss, complication type and free-flap salvage. Results: We identified 679 autologous breast free-flap reconstructions. Fifteen (2.2%) were returned-to-theatre for surgery-related complications during inpatient stay. Eight (1.2%) developed microvascular complications; seven (1.0%) were successfully salvaged and we encountered one free-flap loss (0.1%) due to an arterial complication developing 72-hours postoperatively. Six of the eight microvascular complications (75%) occurred within the first 24 hours from surgery. Surgical time in the takeback population was statistically significantly longer than in the non-takeback population (539 minutes vs. 406 minutes, p=0.00585). Conclusion: Majority of microvascular complications occurred within the first 24-hours in our cohort and these were successfully identified and salvaged at our high-volume practice. We believe all free-flaps should be closely monitored in the first 24-hours. Beyond this period, protocols should be suited to each institution based on their patient demographic, facilities available for free-flap monitoring and case-volume.

Introduction: Delayed autologous breast reconstruction (DBR) is often performed in patients not deemed suitable for immediate breast reconstruction (IBR). Although previous studies suggest a negative impact on oncological outcomes in patients undergoing DBR, little is known about the financial and economic burden. The aim was to compare overall cost in patients undergoing DBR compared to IBR.

Introduction: Post-mastectomy radiotherapy (PMRT) in patients who have undergone immediate autologous breast reconstruction (IBR) increases morbidity and the need for further surgery. However, there remains a paucity of data regarding the financial cost of PMRT in this cohort. The aim was to compare patient level costs between irradiated and unirradiated autologous breast reconstructions.

Background Radiotherapy before mastectomy and autologous free-flap breast reconstruction can avoid adverse radiation effects on healthy donor tissues and delays to adjuvant radiotherapy. However, evidence for this treatment sequence is sparse. We aimed to explore the feasibility of preoperative radiotherapy followed by skin-sparing mastectomy and deep inferior epigastric perforator (DIEP) flap reconstruction in patients with breast cancer requiring mastectomy. Methods We conducted a prospective, non-randomised, feasibility study at two National Health Service trusts in the UK. Eligible patients were women aged older than 18 years with a laboratory diagnosis of primary breast cancer requiring mastectomy and post-mastectomy radiotherapy, who were suitable for DIEP flap reconstruction. Preoperative radiotherapy started 3-4 weeks after neoadjuvant chemotherapy and was delivered to the breast, plus regional nodes as required, at 40 Gy in 15 fractions (over 3 weeks) or 42.72 Gy in 16 fractions (over 3.2 weeks). Adverse skin radiation toxicity was assessed preoperatively using the Radiation Therapy Oncology Group toxicity grading system. Skin-sparing mastectomy and DIEP flap reconstruction were planned for 2-6 weeks after completion of preoperative radiotherapy. The primary endpoint was the proportion of open breast wounds greater than 1 cm width requiring a dressing at 4 weeks after surgery, assessed in all participants. This study is registered with ClinicalTrials.gov, NCT02771938, and is closed to recruitment. Findings Between Jan 25, 2016, and Dec 11, 2017, 33 patients were enrolled. At 4 weeks after surgery, four (12.1%, 95% CI 3.4-28.2) of 33 patients had an open breast wound greater than 1 cm. One (3%) patient had confluent moist desquamation (grade 3). There were no serious treatment-related adverse events and no treatment-related deaths. Interpretation Preoperative radiotherapy followed by skin-sparing mastectomy and immediate DIEP flap reconstruction is feasible and technically safe, with rates of breast open wounds similar to those reported with post-mastectomy radiotherapy. A randomised trial comparing preoperative radiotherapy with post-mastectomy radiotherapy is required to precisely determine and compare surgical, oncological, and breast reconstruction outcomes, including quality of life. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

*Correspondence - Melanie Corbett: melanie@corbwood.co.uk OBJECTIVE: To describe the clinical and histological findings in subconjunctival silicone oil leakage, and a surgical technique for its management. METHOD A 60-year-old woman with a chronic macula-off detachment underwent two pars plana vitrectomies four months apart. The silicone oil inserted during the first was replaced by heavy silicone (Oxane HD) at the second, with unsutured sclerostomy ports. One month later silicone oil cysts were noted under the conjunctiva. RESULTS Symptoms were grittiness, dryness and heaviness with occasional severe pain. Multiple oil globules 0.2 - 2mm in diameter were tightly packed beneath the conjunctiva in two quadrants, extending from limbus to peripheral bulbar conjunctiva.Tenons tissue containing silicone globules was isolated by dissecting planes superficially, immediately beneath the conjunctival basement membrane, and deep, immediately above the sclera. The tissue sheet was mobilised and excised posteriorly at the junction with healthy tissue.Histology revealed sheets of connective tissue with densely packed tiny lacunae, and intermittent large lacunae with fibrous walls. Inflammatory cells were scattered in between. DISCUSSION Injectable medical grade silicone oil is only approved for intravitreal use. When injected into breasts, buttocks or face, or following implant rupture, it can migrate causing inflammation, contracture, calcification, embolism and death. It is difficult to remove surgically as it is viscous and adherent, requiring surfactants. CONCLUSION Leakage of silicone oil from a sclerostomy is a rare complication of intravitreal use. It densely infiltrates subconjunctival tissues, causing irritation and heaviness. With careful dissection, the tissues can be removed en bloc with resolution of symptoms.

Background: Radiotherapy (RT) prior to mastectomy and autologous reconstruction spares healthy donor tissues the adverse effect of radiation, avoiding delay to adjuvant RT due to post-operative healing. However, little is known regarding the surgical safety of RT sequence reversal in this setting. We investigated the feasibility of microvascular anastomosis and surgical safety of deep inferior epigastric perforator (DIEP) breast reconstruction after neoadjuvant radiotherapy (NRT).Methods: PRADA was a multi-centre, non-randomized, observational study in the United Kingdom. Eligible participants were aged 18 years or older, requiring mastectomy either for extensive disease or for positive margins following attempted breast conserving surgery, and requiring PMRT and deemed suitable for a DIEP flap reconstruction. NRT was commenced 2-6 weeks following completion of neoadjuvant chemotherapy (NACT) and intention for surgery within 6 weeks of completion of NRT. Data was prospectively captured on demographic and clinicopathological variables, treatment schedules and timelines, and perioperative complications. Oncological outcomes including loco-regional recurrence (LRR), overall survival (OS) and disease-free survival (DFS) were recorded. The primary outcome was the open wound rate, and the primary end point was the rate of open breast wounds requiring a dressing 4 weeks following surgery. Findings: Between 26th January 2016 and 11th December 2017, 33 patients receiving immediate DIEP breast reconstruction after NRT were enrolled. Median time from NRT completion to surgery was 19·0 days with all completing surgery within 6 weeks of NRT (range=12-39). Microvascular anastomosis was successfully achieved in all patients and there were no DIEP flap failures. In three cases immediate revision anastomosis was required at the index surgery. There were two unplanned returns to the operating room: one <24hrs to assess a congested DIEP flap; the second at 4 weeks for debridement of mastectomy skin flap necrosis and split skin graft. At 4 weeks there was an open wound rate of 12·1% (4/33). After median follow up of 23 months (range 2-41), none had LRR, four had distant metastatic relapses and there were two breast cancer related deaths, with OS 93·9% and DFS 87·8%.Interpretation: NRT prior to mastectomy with immediate DIEP flap reconstruction is technically feasible with rates of mastectomy skin flap necrosis and open wounds analogous to those observed following post-mastectomy radiotherapy. An appropriately powered randomized trial of NRT compared to conventional PMRT is needed to determine more precisely the surgical, oncological, and quality of life outcomes of breast reconstruction.Clinical Trial Registration Details: Registered with clinical trials.gov [NCT02771938].Funding Information: NIHR Imperial BCR, the CR:UK Imperial Centre and the Royal Marsden Hospital.Declaration of Interests: PTRT reports personal fees from Stryker Surgical and Cytoveris. JH reports personal fees from Stryker Surgical. All other authors declare no competing interests.Ethics Approval Statement: Local Regional Ethical Committee (LREC) approval was obtained for the Primary Radiotherapy And DIEP flAp (PRADA) study [15/LO/1071].

The COVID-19 pandemic has changed the way in which elective services are delivered across healthcare. For several months breast reconstruction services were halted. We published guidance on restarting immediate abdominal based reconstructive surgery following mastectomy in the breast cancer setting1Jallali N. Hunter J.E. Henry F.P. Wood S.H. Hogben K. Almufti R. Hadjiminas D. Dunne J. Thiruchelvam P.T.R. Leff D.R. The feasibility and safety of immediate breast reconstruction in the COVID-19 era.J Plast Reconstr Aesthet Surg. Nov 2020; 73: 1917-1923Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar. This included details of patient selection, COVID-19 testing, and recommended in-patient and out-patient follow-up protocols. Here we present our initial data from this service reconfiguration compared to the outcomes to the corresponding time-frame in 2019. During the period of the first peak of COVID-19 within the UK we performed no autologous breast reconstruction from 23rd March at the Imperial College Healthcare NHS Trust Plastic Surgery Unit until our restart on 9th June 2020. From this time until October 8th 2020 we performed 29 immediate free-flap reconstructions on 25 patients. The first six were performed in the private sector owing to lack of capacity within the NHS (Table 1).Table 1Outcomes of immediate autologous free flap breast reconstruction following the first peak of COVID-19.9.06.2020 – 8.10.20209.06.2019 – 8.10.2019Number of patients2538Number of free flaps2944Number patients contracting COVID-190N/AFree flap losses00Immediate:Delayed breast reconstruction29:040:4Mean Age (range)49.5 (23–63)50.3 (31–70)Mean BMI (range)26.4 (20.3–34.6)27.2 (20.3–36.5)Age >7001 (2.6)BMI >30.04 (16%)9 (23.7%)BMI >35.003 (7.9%)Diabetes02Chronic cardiac, renal or respiratory disease1 (4%, well controlled asthma)5 (13.2%)Immunosuppression00Therapeutic:risk reducing mastectony26:3 (90%:10%)40:4 (90.9%:9.1%)Active smoker3 (12%)4 (10.5%)Percentage of Black & Minority Ethnic patients40%36.8%Vitamin D Deficiency11 (44%)N/AMean length of stay (days)3.94.7Number of returns to theatre within 30 days1 (3.4%)1 (2.3%)Mean mastectomy weight (g)532 g552 gMean flap weight (g)613 g564 gNumber of pre-operative face-to-face appointments1.22.2Number of virtual pre-operative appointments1.00Number of post-operative face-to-face nurse-led dressing clinic appointments5.44.1Number of post-operative face-to-face nurse-led dressing clinic appointments, when doctor called to review3.11.8Number of post-operative face-to-face appointments with doctor0.21.2Number of post-operative virtual appointments with doctor0.90 Open table in a new tab As planned, all women referred by the breast surgeons were discussed at a formal oncoplastic breast MDT (run via a virtual platform) to ensure consensus regarding safe patient selection. Those women who fulfilled criteria for consideration of immediate breast reconstruction were seen at a face-to-face appointment pre-operatively, when an abdominal wall perforator mapping CT scan was performed, along with pre-operative blood tests (including vitamin D levels). Vitamin D was supplemented with 10, 000IU daily for 2 weeks pre-operatively, if found to be below 70 nmol/L. Patients who were of Black and Minority Ethnic origin were counselled regarding increased risk of COVID-19 related death2Razaq A. Harrison D. Karunanithi S. Barr B. Asaria M. Khunti K. BAME COVID-19 Deaths - What do We Know? Rapid Data & Evidence Review: 'Hidden in Plain Sight'.2020Google Scholar, but not denied surgery based on ethnicity. The second pre-operative appointment was typically virtual; information was also available via a virtual breast reconstruction seminar. No patient was denied reconstruction on the basis of a CT scan. All patients were admitted on the morning of surgery, and asked to take private-hire or personal transport into hospital. Patients were asked to self-isolate for 14 days pre-operatively, and undergo a PCR COVID-19 antigen test 3 days prior to surgery. Family and friends were not allowed to visit the hospital. Patients were treated within a risk-managed pathway, and were separated from patients with potential or confirmed COVID-19. No patients developed COVID-19 pre-operatively, during their hospital admission, or in the post-operative period. There were no flap losses, and there was one return to theatre within 30 days of surgery, for washout of infected breast seroma. The same pre-operative COVID-19 testing and isolation protocol was employed for this, and she did not develop COVID-19. The mean age of the women was 49.5 years (range 23–63 years old), with a mean BMI of 26.3 (21.0–34.8). Due to the pandemic, we looked to reduce the face-to-face contact with patients, and move to virtual consultations. Pre-operatively, we have evolved from a mean of 2.2 to 1.2 face-to-face consultations, and from zero to one virtual meeting. The mean inpatient stay has reduced from 4.7 to 3.9 days. Although the post-operative dressings clinic visits have increased from 4.1 to 5.4, the post-operative face-to-face consultations with a doctor have decreased from 1.2 to 0.2, with a corresponding increase in virtual doctor-patient interactions (increasing from 0 to 0.9). This demonstrates increased multi-disciplinary contact, where patients are seen by their surgeon and dressing clinic staff concurrently during the pandemic. This therefore facilitates virtual immediate post-operative consultation, reducing patient risk to nosocomial infection. During the pandemic, evidence suggested that age over 65 and BMI over 35 increased the risk of severe COVID-related illness1Jallali N. Hunter J.E. Henry F.P. Wood S.H. Hogben K. Almufti R. Hadjiminas D. Dunne J. Thiruchelvam P.T.R. Leff D.R. The feasibility and safety of immediate breast reconstruction in the COVID-19 era.J Plast Reconstr Aesthet Surg. Nov 2020; 73: 1917-1923Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar. In terms of co-morbidities, our COVID-19 pathway meant that we could no longer offer the surgery to patients with diabetes, those over the age of 70, those with a BMI greater than 35.0, and those with chronic cardiac, respiratory or renal disease. Prior to the pandemic, these alone would not have been contra-indications. All patients were discussed at the oncoplastic MDT, where a consensus was achieved as to the suitability of each patient for surgery. Throughout the pandemic, we continued to follow the published pathway, but also reviewed it regularly, in line with available evidence. We reconsidered offering surgery to patients with diabetes, however, research published following the first peak of COVID-19 suggested that it remained unsafe to do so3Holman N. Knighton P. Kar P. et al.Lancet Diabetes Endocrinol. 2020; 8 (Oct): 823-833Abstract Full Text Full Text PDF PubMed Scopus (617) Google Scholar, 4Barron Bakhai Kar et al.Lancet Diabetes Endocrinol. 2020; 8 (Oct): 813-822Abstract Full Text Full Text PDF PubMed Scopus (651) Google Scholar. Although the intention was to restart delayed breast reconstruction, a second surge in cases has meant that the staff availability could not be guaranteed, and this has therefore not been recommenced as of January 3rd 2020. In summary, our data show that there are mechanisms to provide safe care for these women. Although they do not allow comment on the delayed breast reconstruction pathways, the results support the fact that immediate breast reconstruction in selected women should not be neglected due to the COVID-19 pandemic. This surgery should only be precluded if staff availability is limited, or the surgery is unsafe. None. N/A None.

Introduction: Neoadjuvant radiotherapy may improve reconstructive outcomes in patients with locally advanced node-positive disease who desire breast immediate reconstruction (IMBR) but who would traditionally require post-mastectomy radiotherapy (PMRT). We previously demonstrated similarity in post-operative complication profiles between neoadjuvant radiotherapy (NRT) and PMRT in the setting of immediate autologous reconstruction. The aim of the current paper was to evaluate the benefits of NRT in curtailing treatment times.

Introduction: Evaluation of aesthetics after breast reconstruction is challenging. In the absence of an objective measurement, panel assessment is widely adopted. Heterogeneity of scales and poor internal consistency make comparison difficult. Development and validation of an expert panel scale using a Delphi consensus process is described. It was designed specifically for use as the gold standard for development of an objective evaluation tool using 3-Dimensional Surface Imaging (3D-SI). Materials and methods: 20 items relating to aesthetic assessment were identified for consideration in the Delphi consensus process. Items were selected for inclusion in the definitive panel scale by iterative rounds of voting according to importance, consensus discussion, and a final vote. The Delphi-derived scale was tested on a clinical research series for intra- and inter-panellist, and intra-panel reliability, and correlation with Patient Reported Outcome Measures (PROMs). Results: 61 surgeons participated in the Delphi process. Oncoplastic and plastic surgeons were represented. The Delphi-derived scale included symmetry, volume, shape, position of breast mound, nipple position, and a global score. Intra-panellist reliability ranged from poor to almost perfect (w kappa<0to0.86), inter-rater reliability was fair (ICC range 0.4-0.5) for individual items and good (ICC0.6) for the global score, intra-panel reliability was moderate to substantial (w kappa 0.4-0.7), and correlation with PROMs was moderate (r = 0.5p < 0.01). Conclusions: The Delphi-derived panel evaluation is at least as good as other scales in the literature and has been developed specifically to provide expert evaluation of aesthetics after breast reconstruction. The logistical constraints of panel assessment remain, reinforcing the need to develop an objective evaluation method. (C) 2020 The Authors. Published by Elsevier Ltd.

The coronavirus disease-2019 pandemic has had a significant impact on the delivery of surgical services, particularly reconstructive surgery. This article examines the current evidence to assess the feasibility of recommencing immediate breast reconstruction services during the pandemic and highlights considerations required to ensure patient safety.

The coronavirus disease-2019 pandemic has had a significant impact on the delivery of surgical services, particularly reconstructive surgery. This article examines the current evidence to assess the feasibility of recommencing immediate breast reconstruction services during the pandemic and highlights considerations required to ensure patient safety. (C) 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Introduction: Many reconstructive surgeons are reluctant to offer immediate, autologous reconstruction if women are likely to receive post-mastectomy radiotherapy (PMRT). This is due to historical evidence of higher rates of complications as well as poorer aesthetic outcomes. This multicentre trial evaluates the feasibility and safety of offering radiotherapy prior to mastectomy and immediate DIEP flap reconstruction (ClinicalTrials.gov Identifier: NCT02771938).