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Operative Time And RVU Efficiency Of Nipple-Areola Complex Neurotization In Breast Reconstruction: A National NSQIP Study
Nitya Devisetti, B.S., Pusti Shah, B.S., MBA,
Nishitha Chaayanath, B.S., Alex K. Wong, MD.
Rutgers New Jersey Medical School, Newark, NJ, USA.
PURPOSE: Nipple neurotization, where sensory nerves are coapted to restore nipple-areola complex sensibility, is increasingly incorporated into breast reconstruction. Despite growing adoption, there is no breast reconstruction-specific CPT code for neurotization, leaving benchmarks for operative efficiency undefined. We used ACS NSQIP data to assess surgeon compensation for this procedure.
METHODS: ACS-NSQIP files (2005-2023) were queried for breast reconstruction cases. Neurotization was identified by concurrent nerve repair codes (64910-64912, 64831-64868). Operative times below the 10th and above the 90th percentiles were excluded. Median operative time (IQR) and wRVU/hour were compared to non-neurotization cases using Wilcoxon rank-sum tests. Linear regression modeled change in operative time.
RESULTS: Of 326,803 cases, 989 (0.3%) included neurotization, with rising counts peaking in 2023 (n=277). Median operative time was 432 minutes (IQR 210) for neurotization versus 152 (IQR 147) for non-neurotization (+280 min, p<0.001). Median wRVU/hour was 5.15 versus 6.43 for non-neurotization (−20% efficiency). Neurotization time declined significantly each year (β = −11.99 min/year, p<0.001), while non-neurotization increased modestly (p<0.001).
CONCLUSION: Nipple neurotization significantly prolongs breast reconstruction but is only tracked under generic nerve repair codes, without a dedicated CPT code or wRVU valuation. Our data show a substantial efficiency penalty and increasing adoption. Reduced operative time suggests improved technique. Despite patient benefits, surgeons face lower RVU efficiency, underscoring the need for CPT code creation and wRVU revaluation to align reimbursement with operative effort.
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