title: Cost and outcome analysis of breast reconstruction paradigm shift.
abstract: 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.
authors: 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.
authors: Aisling M
authors: AM
authors: Fitzpatrick
authors: Lin Lin
authors: LL
authors: Gao
authors: Barbara L
authors: BL
authors: Smith
authors: Curtis L
authors: CL
authors: Cetrulo
authors: Amy S
authors: AS
authors: Colwell
authors: Jonathan M
authors: JM
authors: Winograd
authors: Michael J
authors: MJ
authors: Yaremchuk
authors: William G
authors: WG
authors: Austen
authors: Eric C
authors: EC
authors: Liao
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D001943:Breast Neoplasms / Q000191:economics / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D016462:Mammaplasty / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D008408:Mastectomy / Q000191:economics; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D015626:Tissue Expansion / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D016896:Treatment Outcome