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Single-stage breast reconstruction cost-effective compared with two-stage reconstruction

Single-stage prosthetic breast reconstruction was a cost-effective operation compared with expander-implant breast reconstruction, according to study results published in Plastic and Reconstructive Surgery.

“Prosthetic breast reconstruction is most commonly performed using the two-stage (expander-implant) technique,” Naveen M. Krishnan, MD, MPhil, of the department of plastic surgery, Georgetown University Hospital, and colleagues wrote. “However, with the advent of skin sparing mastectomy, and the use of acellular dermal matrices, one-stage prosthetic reconstruction has become more feasible.”

To conduct a comprehensive literature review, Krishnan and colleagues searched Medline, Embase and Cochrane databases for studies that directly compared matched patient cohorts undergoing single-stage or staged breast prosthetic reconstruction. There were six studies selected, which included 791 direct-to-implant and 1,142 expander-implant reconstructions. Patient and third-party payer perspectives were used to estimate costs, with third-party perspective representing Medicare reimbursement.

There was a 35% overall complication rate for single-stage reconstruction and a 34% overall complication rate for expander-implant reconstruction.

There was a cost decrease of $525.25 when performing single-stage reconstructions and a clinical benefit of 0.89 quality-adjusted life year, according to baseline analysis using Medicare reimbursement.

“When using national billing, the incremental cost-utility further decreased, indicating that direct-to-implant breast reconstruction was the dominant strategy,” the researchers wrote.

Sensitivity analysis confirmed that direct-to-implant reconstruction remained cost-effective relative to expander-implant reconstruction.

Both procedures had similar complication and infection rates. Single-stage reconstructions had a higher rate of mastectomy skin necrosis and capsular contracture, whereas expander-implant reconstructions had higher rates of hematoma and seromas.

“Because of the cost differential and psychological impact of having another procedure, single-stage reconstruction remains cost effective despite varying the complication rate, operating room time, acellular dermal matrix use, or inpatient cost,” the researchers concluded. “Patient selection is till essential for successful reconstruction.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.