title: Cost comparison of immediate one-stage and tissue-expander breast reconstructions after mastectomy in commercially insured patients.
abstract: OBJECTIVE
  Growing acceptance of nipple-sparing mastectomy and rising rates of prophylactic mastectomy due to genetic findings make immediate one-stage implant breast reconstruction an attractive option for many American women facing post-mastectomy breast reconstruction. We compared medical services utilization and cost of immediate one-stage reconstruction with that of the more common tissue-expander (TE) breast reconstruction.
  
  
  METHODS
  Retrospective administrative claims database analysis.
  
  
  METHODS
  We obtained commercial insurance claims on patients in the U.S. who had undergone one-stage or TE post-mastectomy implant breast reconstructions in 2008, and we compared 18-month results in terms of the frequency and cost of return visits for additional procedures and/or for the treatment of complications. Return visits were categorized as planned, planned with revision, or unplanned.
  
  
  RESULTS
  Among 1,316 immediate implant breast reconstructions, 95 (7%) were one-stage procedures and 1,221 (93%) were TE reconstructions. The data showed a modest, nonsignificant trend toward fewer return visits after one-stage reconstruction versus TE reconstruction (191 vs. 242 visits per 100 patients, respectively; relative risk [RR]: 0.95). Patients with TE reconstructions returned more often for planned returns and planned returns with revisions. Patients with one-stage reconstructions returned more often for unplanned events. The total costs over 18 months were $34,839 and $39,062 for one-stage and TE reconstructions, respectively, for a difference of -$4,223 (P = 0.38). The initial reconstruction, including the mastectomy, accounted for 64% of the 18-month costs with one-stage reconstructions and for 54% of the 18-month costs for TE reconstructions.
  
  
  CONCLUSIONS
  Costs and utilization trended lower over 18 months for one-stage versus TE reconstructions following post-mastectomy breast reconstructions but did not achieve statistical significance.
authors.affiliation: Washingtonian Plastic Surgery, 5454 Wisconsin Ave., Ste. 1710, Chevy Chase, MD 20815, USA. doctor@washingtonianplasticsurgery.com
authors.forename: Navin K
authors.initials: NK
authors.lastname: Singh
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Reaven
authors.forename: Susan E
authors.initials: SE
authors.lastname: Funk
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000191:economics* / Q000379:methods; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D016462:Mammaplasty / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D008408:Mastectomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics* / Q000453:epidemiology; D012189:Retrospective Studies; D015625:Tissue Expansion Devices / Q000009:adverse effects / Q000191:economics; D055815:Young Adult