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Trends in Physician Payments for Breast Reconstruction

Sheckter, Clifford C. M.D.; Yi, Day M.S.; Panchal, Hina J. M.D.; Razdan, Shantanu N. M.D., M.P.H.; Pusic, Andrea L. M.D., M.H.S.; McCarthy, Colleen M. M.D., M.P.H.; Cordeiro, Peter G. M.D.; Disa, Joseph J. M.D.; Mehrara, Babak M.D.; Matros, Evan M.D., M.M.Sc., M.P.H.


The authors of the April 2018 Breast article entitled “Trends in Physician Payments for Breast Reconstruction” ( Plast Reconstr Surg . 2018;141:493e–499e) regret that the fourth author, David Rubin, was mistakenly left off the final version. The authors would like to update the author list to read as follows:

In addition, the affiliation footnote should have read as follows:

From Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine; and Health Outcomes and Quantitative Analytics, Department of Finance, and Plastic and Reconstructive Service, Department of Surgery, Memorial Sloan Kettering Cancer Center.

The financial disclosure statement remains accurate as initially written.

Plastic and Reconstructive Surgery. 142(3):833, September 2018.

Plastic and Reconstructive Surgery: April 2018 - Volume 141 - Issue 4 - p 493e-499e
doi: 10.1097/PRS.0000000000004205
Breast: Original Articles

Background: Prosthetic breast reconstruction rates have risen in the United States, whereas autologous techniques have stagnated. Meanwhile, single-institution data demonstrate that physician payments for prosthetic reconstruction are rising, while payments for autologous techniques are unchanged. This study aims to assess payment trends and variation for tissue expander and free flap breast reconstruction.

Methods: The Blue Health Intelligence database was queried from 2009 to 2013, identifying women with claims for breast reconstruction. Trends in the incidence of surgery and physician reimbursement were characterized by method and year using regression models.

Results: There were 21,259 episodes of breast reconstruction, with a significant rise in tissue expander cases (incidence rate ratio, 1.09; p < 0.001) and an unchanged incidence of free flap cases (incidence rate ratio, 1.02; p = 0.222). Bilateral tissue expander cases reimbursed 1.32 times more than unilateral tissue expanders, whereas bilateral free flaps reimbursed 1.61 times more than unilateral variants. The total growth in adjusted tissue expander mean payments was 6.5 percent (from $2232 to $2378) compared with −1.8 percent (from $3858 to $3788) for free flaps. Linear modeling showed significant increases for tissue expander reimbursements only. Surgeon payments varied more for free flaps (the 25th to 75th percentile interquartile range was $2243 for free flaps versus $987 for tissue expanders).

Conclusions: The incidence of tissue expander cases and reimbursements rose over a period where the incidence of free flap cases and reimbursements plateaued. Reasons for stagnation in free flaps are unclear; however, the opportunity cost of performing this procedure may incentivize the alternative technique. Greater payment variation in autologous reconstruction suggests the opportunity for negotiation with payers.

Stanford, Calif.; and New York, N.Y.

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Clinical Excellence Research Center, Department of Medicine, Stanford University; and the Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center.

Received for publication August 31, 2017; accepted October 24, 2017.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Evan Matros, M.D., M.M.Sc., M.P.H., Memorial Sloan Kettering Cancer Center, 1275 York Avenue, MRI 1036, New York, N.Y. 10065,

Copyright © 2018 by the American Society of Plastic Surgeons