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American Association of Plastic Surgeons

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Five Year Cost Comparison Of Secondary Procedures Following Autologous And Implant Based Breast Reconstruction
Christine A. Schaeffer, MD, Grace Forster, BS, Brian Werner, MD, Brent R. DeGeorge, MD PhD, Chris A. Campbell, MD.
University of Virginia, Charlottesville, VA, USA.

PURPOSE: Cost analyses comparing implant to autologous reconstruction have focused on index operative costs with short term reporting of complications data. This report of a national insurance database compares total number of secondary operations and total surgical costs of patients having autologous and implant based reconstruction over the five years subsequent to mastectomy. METHODS: Patients having undergone mastectomy and either immediate expander or autologous breast reconstruction from 2013-2018 were identified through the Humana insurance database. Demographics, comorbid conditions, and subsequent operations as well as complications requiring surgery and surgical costs over the subsequent five years are reported and compared. RESULTS: 462 patients underwent immediate autologous reconstruction and 4545 patients immediate expander placement with 5 year follow-up. There were no significant differences in age trends for reconstructive choice or comorbidities between groups. After autologous reconstruction, 6% required a second flap and 3% abdominal bulge repair. Fifty-five percent underwent flap revision, 21.2% abdominal scar revision, 40.5% nipple reconstruction, 8.4% implant placement, 18.8% fat grafting. After expander placement, 1% had flap reconstruction, 4.3% mastectomy incision repair, 11.8% explantation, and 2.3% implant rupture. Eighty percent had secondary implant placement, 24% underwent nipple reconstruction, 31.8% revision of the reconstructed breast, 8.3% fat grafting. Over the 5 years after flap reconstruction, surgical costs averaged $11,262.41 (1.67 CPT codes) as compared to $11,059.31 (1.82 CPT codes) after expander placement. CONCLUSIONS: There were no differences in the surgical costs or number of secondary operations in the 5-year period following mastectomy and immediate autologous or expander based breast reconstruction.


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