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Cost and Outcome Analysis of Breast Reconstruction Paradigm Shift

Fitzpatrick, Aisling M. BPHE*; Gao, Lin Lin MD*; Smith, Barbara L. MD, PhD; Cetrulo, Curtis L. Jr MD*; Colwell, Amy S. MD*; Winograd, Jonathan M. MD*; Yaremchuk, Michael J. MD*; Austen, William G. Jr MD*; Liao, Eric C. MD, PhD*‡

doi: 10.1097/SAP.0b013e318276d979
Breast Surgery
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Increased bilateral mastectomy for breast cancer treatment has generated an increased demand for bilateral breast reconstruction. This study examines changing patterns of reconstruction over the last decade to accommodate increased case volume and decreased morbidity associated with reconstruction. A single institution series of 3171 consecutive breast reconstruction cases of more than 10 years was divided into 2 periods, that is, 1999 to 2004 and 2005 to 2010. Bilateral breast reconstruction case volume increased 260% from 1999 to 2004 (n = 237) to 2005 to 2010 (n = 634). Mean patient age at diagnosis decreased by 7 years (P < 0.001). In 2005 to 2010, autologous reconstruction decreased from 60% to 26%, implant-based reconstruction increased from 40% to 74%. There was a noted increase in single-stage implant reconstruction and selective application of perforator flaps for bilateral autologous reconstruction (P < 0.001). Two-staged tissue expander reconstruction accounted for the greatest share of total cost (45%) in the later period. A younger patient demographic and increased case volume were accommodated through increased single-staged and prosthesis-based procedures.

From the *Division of Plastic and Reconstructive Surgery, †Division of Surgical Oncology, Breast Cancer Program, Massachusetts General Hospital, Harvard Medical School; and ‡Center for Regenerative Medicine, Harvard Stem Cell Institute, Boston, MA.

Received July 11, 2012, and accepted for publication, after revision, September 28, 2012.

Presented at the New England Society of Plastic and Reconstructive Surgery, June 2012.

Conflicts of interest and sources of funding: Supported by the American Surgical Association Research Fellowship, Plastic Surgery Education Foundation, Harvard Stem Cell Institute, the March of Dimes Basil O’Connor Starter Scholar Award, and the Shriners Hospitals for Children (E.C.L.).

E.C.L. formulated the study and supervised the data collection, data analysis, and prepared the manuscript and its revisions. A.M.F. and L.L.G. performed chart reviews, data collection, statistical analysis, and prepared the manuscript. All other coauthors reviewed the manuscript and its revisions, and participated in this study.

This study was approved by the Massachusetts General Hospital Internal Review Board, with rules and regulations conforming to the Declaration of Helsinki.

The preliminary data presented in this manuscript were presented at the Annual Meeting of the Plastic Surgery Research Council, April, 2011.

Reprints: Eric C. Liao, MD, PhD, Massachusetts General Hospital, Harvard Medical School, WACC 435, 15 Parkman St, Boston, MA 02114-3117. E-mail: cliao@partners.org.

© 2014 by Lippincott Williams & Wilkins