title: Resource implications of risk-reducing mastectomy and reconstruction.
abstract: OBJECTIVE
  Risk-reducing mastectomy (RRM) is on the increase, now frequently combined with breast reconstruction (BR). However, the resource implications associated with bilateral mastectomy and reconstruction are unknown. This study assessed the overall cost of performing risk-reducing surgery.
  
  
  METHODS
  All cases of RRM and BR performed between 1991 and 2011 at this hospital were identified from a prospectively collected database. All patients undergoing bilateral mastectomy were included, when at least one mastectomy was risk-reducing. Overall treatment costs for all surgical procedures, complications, revisional procedures and outpatient attendances were calculated and compared to the National Tariff allowed. Mann-Whitney U and Fischer's exact tests were used to calculate levels of significance.
  
  
  RESULTS
  Fifty patients underwent bilateral mastectomy and BR (median follow up 20 [range 1-106] months), 72 were Latissimus Dorsi reconstructions (LDR) and 28 were Subpectoral reconstructions (SPR). LDR took longer than SPR (p = 0.001), with a greater length of stay (p = 0.024). Nine percent of patients returned to theatre for early complications, but the type of BR did not influence the early complication rate (LDR versus SPR, p = 0.345) or the need for additional unplanned procedures (LDR versus SPR, p = 0.671). The overall mean cost for bilateral RRM and BR was £14,797 per patient. The inpatient cost for bilateral RRM and LDR was £10,082 compared with £5,905 SPR. Both procedures exceeded the £5,697 tariff allowed in the UK.
  
  
  CONCLUSIONS
  Bilateral RRM and BR is a safe procedure, but the resource implications are considerable and exceed the tariff allowed, particularly when performing more complex techniques.
authors.affiliation: Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Robertson
authors.affiliation: Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK.
authors.forename: C M
authors.initials: CM
authors.lastname: Summerhayes
authors.affiliation: Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK.
authors.forename: S
authors.initials: S
authors.lastname: Laws
authors.affiliation: Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK. Electronic address: RRainsbury@aol.com.
authors.forename: R M
authors.initials: RM
authors.lastname: Rainsbury
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D006295:Health Resources / Q000191:economics*; D006801:Humans; D016462:Mammaplasty / Q000191:economics* / Q000379:methods; D008408:Mastectomy / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D012189:Retrospective Studies; D040242:Risk Reduction Behavior; D006113:United Kingdom
keywords: Breast reconstruction; Cost; Risk reducing mastectomy