Cost of Care and Surgical Outcomes Between Direct-To-Implant and Staged Tissue-Expander Breast Reconstruction.

Abstract

Implant based breast reconstruction (IBBR) can be performed in a single-stage (direct to implant [DTI]) or two stages using a tissue expander (TE). Fixed costs and post-operative complications can incur a significant financial burden. Here, we compare direct costs of DTI to TE IBBR and determine price drivers to ascertain their relative costs. A retrospective chart review and analysis of specific cost data provided by institutional finance department of patients who underwent implant-based BR was conducted to evaluate differences in costs during an episode of care (EOC). Multivariable regression analysis and one-way sensitivity analysis were conducted to determine key price drivers for each operation. 205 patients (310 breasts) undergoing DTI (n = 167, 54%) or staged TE (n = 143, 46%) reconstruction were evaluated over their entire EOC. The DTI cohort had a lower rate of major complications (13% vs 22%, p = 0.033) but similar rates of aesthetic revisions (18% vs 19%, p = 0.835). The average cost of a DTI ($13,719.39 ± $5,499) was significantly lower than for staged TE patients ($16,589.54 ± $6,586.95, p < 0.001), with lower operative costs ($10,460.2 ± $4,059.81 and $12,242.87 ± $4,403.81, p = 0.002) and number of postoperative visits (13.27 ± 7.76 and 23.03 ± 9.05 , p < 0.001). There were no differences in operative costs from complications and aesthetic revisions. The cost of a DTI reconstruction is most sensitive to the rate of bilateral operations. For staged TE, the episodic cost is most sensitive to the incorporation of acellular dermal matrices. DTI BR incurs lower cost over an EOC compared to staged TE reconstruction, due to greater planned operative costs and number of postoperative follow-ups.