Plastic and Reconstructive Surgery

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PRSonally Speaking
Thursday, February 13, 2014
Articles of Interest Sneak Peak: Comparative Analysis of 18-Month Outcomes and Costs of Breast Reconstruction Flap Procedures
At least twice a month, PRSonally Speaking posts full abstracts of interesting or potentially controversial articles from a future issue. This 'sneak preview' of a hot article is meant to give you some food for thought and provide you with topic for conversation among colleagues.
When the article is published in print with the March issue, it will be FREE for a period of Two Months, to help the conversation continue in the PRS community and beyond. So read the abstract, join the conversation and spread the word.
This week we present the introduction to "Comparative Analysis of 18-Month Outcomes and Costs of Breast Reconstruction Flap Procedures" by Israeli et al.

Background: Data from large-scale studies of breast reconstruction surgery outcomes and downstream costs are lacking. We assessed outcomes, patient return rates, and
costs across a large, geographically diverse patient population undergoing autologous breast reconstruction.

Methods: Insurance claims for patients undergoing free flap, latissimus dorsi (LD) flap, or transverse rectus abdominus myocutaneous (TRAM) flap autologous breast reconstruction were extracted from a US healthcare database. Claims for an 18-month period after the initial (index) procedure were analyzed to assess episodes of care, complications, breast procedures, and costs.

Results: Of 828 patients (274 free, 302 LD, 252 TRAM), 35% experienced post-index complications; incidences related to implant/graft/mesh and hematoma/seroma highest in the LD flap arm (19% and 6%, respectively); breast necrosis highest in the free flap arm (8%); and wound complications highest in the TRAM flap arm (6%). Patient returns for complications were 92.7, 84.4, and 115.5/100 patients in the free, LD, and TRAM flap arms (p < 0.05, TRAM vs other arms) and were 105.5, 116.6, and 87.7/100 patients, respectively, for procedures unrelated to complications (p < 0.05, LD vs
TRAM). Nearly all patients returned at least once for treatments unrelated to complications. Mean total costs for index surgery plus post-index events were $56,205, $30,783, and $33,380 in the free, LD, and TRAM flap arms, respectively.
Conclusions: 18-month complication and return rates for post-index events were similar across study arms. The frequency of returns and associated cost of procedures unrelated to complications points to the inherently staged nature of autologous breast reconstruction.
The full article will be published with the March 2014 issue of PRS, and will be free online for non-subscribers. Until then, we hope this "sneak peek" will pique your interests and start a healthy, meaningful conversation.
About the Blog

Plastic and Reconstructive Surgery

PRSonally Speaking is the official blog of Plastic and Reconstructive Surgery, the journal of the American Society of Plastic Surgeons. Visit our blog for exclusive previews of and discussions on hot topics in plastic surgery as well as insider-tips on open access content. PRSonally Speaking is now powered by frequent contributions from the American Society of Plastic Surgeons’ Young Plastic Surgeons Forum (YPS); these practicing plastic surgeons provide the personal side of the plastic surgery story, from daily challenges to unique insights. PRSonally Speaking is home to lively, civil debate on hot topics and great discussions pertaining to our field. So, bookmark us, subscribe to the RSS feed and join in the on-going conversation with Plastic and Reconstructive Surgery. This is your Journal; have fun, be respectful, get engaged and interact with the PRS community.

The views and recommendations of guest contributors do not necessarily indicate official endorsements or opinions of the Journal, PRS, or the ASPS. All views are those of the authors and the authors alone.


Anureet K. Bajaj, MD is a practicing plastic surgeon in Oklahoma City. She completed residency and fellowship in 2004, had a brief stint in academia at the University of Cincinnati, and then chose to join her father (Paramjit Bajaj MD, also a practicing plastic surgeon) in private practice in OKC, where she focuses on breast reconstruction and general cosmetic surgeries.

Devra B. Becker, MD, FACS, is an Assistant Professor of Plastic Surgery in the Department of Plastic Surgery at University Hospitals/Case Western Reserve University School of Medicine in Cleveland, Ohio. She completed Plastic Surgery residency at Washington University School of Medicine in St. Louis, and completed fellowships with Daniel Marchac and with Bahman Guyuron. She currently has a primarily reconstructive practice.

Henry C. Hsia, MD, FACS is at Robert Wood Johnson Medical School of Rutgers University in New Brunswick, New Jersey and also holds an appointment at Princeton University.  When he’s not working hard trying to be a good father and husband, he runs a practice focused on reconstructive surgery and wound care as well as a research lab focused on wound biology and regenerative medicine.

Stephanie K. Rowen, MD is a senior physician at The Permanente Medical Group in San Jose, California.  She joined TPMG upon finishing residency and a hand surgery fellowship in 2005.  She has a primarily reconstructive practice, about 50% hand surgery.  Outside of work she enjoys participating in triathlons and spending time with her family.

Jon Ver Halen, MD is currently Chief of plastic surgery, Baptist Cancer Center; Research member, Vanderbilt- Ingram Cancer Center; Adjunct clinical faculty, St. Jude Children's Research Hospital. He also acts as Program Director for the plastic surgery microvascular surgery fellowship. His practice focuses on oncologic reconstruction.

Tech Talk Bloggers

Adrian Murphy is a plastic surgery trainee in London, England. He studied medicine in Dublin, Ireland and has trained in Ireland, Boston, MA and the United Kingdom. He is a self-confessed geek and gadget aficionado.

Ash Patel, MD is Assistant Professor of Plastic Surgery and Associate Program Director at Albany Medical College, in Albany NY. His practice is primarily reconstructive.