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Back to 2017 Program


Cost Effectiveness and Utility of Routine Pathologic Evaluation of Plastic Surgery Specimens
Mark Fisher, MD1, Brandon Alba, BA2, Tawfiqul Bhuiya, MD1, Armen K. Kasabian, MD1, Charles H. Thorne, MD1, Neil Tanna, MD MBA1.
1Northwell Health, Great Neck, NY, USA, 2Hofstra Northwell School of Medicine, Hempstead, NY, USA.

PURPOSE: Recent healthcare changes have encouraged efforts to decrease costs. In plastic surgery, an area of potential cost savings includes appropriate utilization of Pathology. Specimens are frequently sent because of hospital policy or insurance request, even when clinically unnecessary. This is an area where evidence-based guidelines are lacking and significant cost-savings can be achieved.
METHODS: All specimen submissions to pathology at two hospitals between 1/2015-12/2015 were queried for tissue expanders, breast implants, fat, skin, abdominal pannus, implant capsule, hardware, rib, bone, cartilage, scar, and keloid. Specimens not related to plastic surgery procedures were excluded. Pathological diagnosis and cost data were obtained.
RESULTS: A total of 571 specimens were identified (Table 1). Of these, 145 were sent with a specific request for gross examination only. There was one incidental finding of a seborrheic keratosis on breast skin. Overall expenditure in 2015 was $326,102.90, of which $18,332.32 was spent on tissue expanders and breast implants. Extrapolated nationally, tissue expanders and implants sent to pathology may cost as much as $20,000,000 annually.
CONCLUSION: The infrequency of clinically significant pathology results does not support routine pathologic examination of all Plastic Surgery specimens. Instead, the authors justify select submission only when there is clinical suspicion or medical history that warrants evaluation. By eliminating unnecessary histological or macroscopic examination, significant cost savings may be obtained.
Table 1.
Specimen TypeNumberFindingsCost
Scar86 (19 Breast)0$48,252.88 ($9,682.62 Breast Specimens)
Skin31 (21 Breast)1$14,923.69 ($8,490.29 Breast Specimens)
Keloid40$3,050.83
Breast Implant600$13,981.87
Tissue Expander210$4,350.45
Breast Capsule300$13,669.92
Abdominal Pannus80$4,024.93
Cartilage3530$223,625.23
Total5941$326,102.90


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