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Comparing Health Care Resource Use between Implant and Autologous Reconstruction of the Irradiated Breast: A National Claims-Based Assessment

Aliu, Oluseyi M.D., M.S.; Zhong, Lin M.D., M.P.H.; Chetta, Matthew D. M.D.; Sears, Erika D. M.D., M.S.; Ballard, Tiffany M.D.; Waljee, Jennifer F. M.D., M.S.; Chung, Kevin C. M.D., M.S.; Momoh, Adeyiza O. M.D.

Plastic and Reconstructive Surgery: June 2017 - Volume 139 - Issue 6 - p 1224e–1231e
doi: 10.1097/PRS.0000000000003336
Breast: Outcomes Articles

Background: In the debate on reconstruction of the irradiated breast, there is little information on associated health care resource use. Nationwide data were used to examine health care resource use associated with implant and autologous reconstruction. It was hypothesized that failure rates would contribute the most to higher average cumulative cost with either reconstruction method.

Methods: From the 2009 to 2013 MarketScan Commercial Claims and Encounters database, irradiated breast cancer patients who underwent implant or autologous reconstruction were selected. In a 24-month follow-up period, the cumulative costs of health care services used were tallied and described. Regression models stratified by reconstruction method were then used to estimate the influence of failure on cumulative cost of reconstruction.

Results: There were 2964 study patients. Most (78 percent) underwent implant reconstruction. The unadjusted mean costs for implant and autologous reconstructions were $22,868 and $30,527, respectively. Thirty-two percent of implant reconstructions failed, compared with 5 percent of autologous cases. Twelve percent of the implant reconstructions had two or more failures and required subsequent autologous reconstruction. The cost of implant reconstruction failure requiring a flap was $47,214, and the cost for autologous failures was $48,344. In aggregate, failures constituted more than 20 percent of the cumulative costs of implant reconstruction compared with less than 5 percent for autologous reconstruction.

Conclusions: More than one in 10 patients who had implant reconstruction in the setting of radiation therapy to the breast eventually required a flap for failure. These findings make a case for autologous reconstruction being primarily considered in irradiated patients who have this option available.

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Ann Arbor, Mich.

From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System.

Received for publication July 21, 2016; accepted November 15, 2016.

Presented at the 95th Annual Meeting of the American Association of Plastic Surgeons, New York, New York, May 19 through 22, 2016.

Disclosure: The authors have no financial interests to declare.

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Adeyiza O. Momoh, M.D., Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109-0340,

©2017American Society of Plastic Surgeons