Impact of COVID-19 Infection and Vaccination on Abdominal-based Microvascular Breast Reconstruction Outcomes

SARS-CoV-2 (COVID-19) infection increases thrombotic risk; however, its impact on microsurgical breast reconstruction outcomes remains unclear. This study examines postoperative complications in patients following abdominal-based microvascular breast reconstruction relative to (1) timing relative to the COVID-19 pandemic, (2) history of COVID-19 infection, and (3) time since COVID-19 vaccination/booster.

A retrospective review of patients who underwent abdominal-based microvascular breast reconstruction was conducted. Patients were categorized into pre-COVID-19 (January 23, 2017-January 19, 2020, n = 236) and post-COVID-19 (January 20, 2020-October 17, 2022, n = 233) groups. The post-COVID-19 group was further stratified by COVID-19 infection history and vaccination/booster status, within 40 days before surgery. Sociodemographic, clinical, and postoperative complication data were analyzed.

The sample included 469 patients with a median age of 50 years and mean body mass index of 28.6 kg/m². The post-COVID-19 group had more former smokers (74 versus 35, P = 0.001) and more bilateral reconstructions (157 versus 126), but no significant differences in intraoperative anastomotic revisions or major complications. Within the post-COVID-19 cohort, 24 patients (10.4%) had prior COVID-19 infection, 178 (76.4%) were previously vaccinated, and 20 (11.3%) received vaccination/booster within 40 days before surgery. There were no significant differences in complications between patients with or without COVID-19 history, or between those vaccinated within 40 days before versus more than 40 days before surgery.

Postoperative complication rates were similar between pre- and post-COVID-19 cohorts. COVID-19 infection or recent vaccination within 40 days before surgery was not associated with increased risk of major complications, including thrombotic events, in abdominal-based microvascular breast reconstruction.