American Association of Plastic Surgeons

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Aesthetic Flat Closure: Assessing The Financial And Clinical Viability Of An Emerging Post-mastectomy Option
Hibo M. Wehelie, BS, Robert G. DeVito, MD, Jessica Pawly, MD, Christopher Campbell, MD, Scott Hollenbeck, MD.
University of Virginia, Charlottesville, VA, USA.

PURPOSE: In this study, we assess the surgical outcomes and financial viability of aesthetic flat closure (AFC), an option growing in popularity. METHODS: A retrospective analysis of patients who underwent mastectomy for breast cancer or elevated cancer risk (2017-2022) was done. Financial data were analyzed to compare AFC with autologous reconstruction (AR) and implant-based reconstruction (IBR). Comparisons of revision rates, follow-up visits, operative time, and postoperative outcomes between AFC and mastectomy alone (MA) were included.RESULTS: AR showed a reimbursement rate of 99.9% (263/264 cases) and an average direct margin of $8,135.18 per case, and IBR with a reimbursement rate of 98.6% (720/730 cases) and a direct margin of $4,614.20 per case. AFC demonstrated a comparable reimbursement rate of 100% (21/21 cases) with a direct margin of $7,006 per case. The average operative time for mastectomy with AFC was 218 minutes, approximately 93 minutes longer than MA (125 minutes). Both AFC (n=30) and MA (n=201) averaged 2 follow-up visits and near 0% revision rate. Rate of minor complications of AFC and MA was comparable at 17% and 15%, respectively (p = 1).CONCLUSION: AFC is a financially viable and clinically safe option for patients choosing not to pursue reconstruction.

Financial Data by Procedure Type
ProcedureReimbursement RateDirect Margin ($) per case
Aesthetic Flat Closure1007,006
Implant-Based Reconstruction99.94,614.20
Autologous Reconstruction98.68,135.18



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