Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Mar;133(3):471-479.
doi: 10.1097/PRS.0000000000000064.

Comparative analysis of 18-month outcomes and costs of breast reconstruction flap procedures

Ron Israeli  1 , Susan Funk, Nancy L Reaven
Affiliations

Comparative analysis of 18-month outcomes and costs of breast reconstruction flap procedures

Ron Israeli et al. Plast Reconstr Surg. 2014 Mar.

Abstract

Background: Data from large-scale studies of breast reconstruction surgery outcomes and downstream costs are lacking. The authors assessed outcomes, patient return rates, and costs across a large, geographically diverse patient population undergoing autologous breast reconstruction.

Methods: Insurance claims for patients undergoing free flap, latissimus dorsi flap, or transverse rectus abdominis myocutaneous (TRAM) flap autologous breast reconstruction were extracted from a U.S. health care database. Claims for an 18-month period after the initial (index) procedure were analyzed to assess episodes of care, complications, breast procedures, and costs.

Results: Of 828 patients (274 free flaps, 302 latissimus dorsi flaps, and 252 TRAM flaps), 35 percent experienced postindex complications: incidences related to implant/graft/mesh and hematoma/seroma were highest in the latissimus dorsi arm (19 percent and 6 percent, respectively); the incidence related to breast necrosis was highest in the free flap arm (8 percent); and that related to wound complications was highest in the TRAM arm (6 percent). Returns for complications were 92.7, 84.4, and 115.5 of 100 patients in the free, latissimus dorsi, and TRAM flap arms (p < 0.05, TRAM flap versus other arms), respectively, and 105.5, 116.6, and 87.7 of 100 patients, respectively, for procedures unrelated to complications (p < 0.05, latissimus dorsi versus TRAM flaps). Nearly all patients returned at least once for treatments unrelated to complications. Mean total costs for index surgery plus postindex events were $56,205, $30,783, and $33,380 in the free, latissimus dorsi, and TRAM flap arms, respectively.

Conclusions: Eighteen-month complication and return rates for postindex events were similar across study arms. The frequency of returns and associated cost of procedures unrelated to complications point to the inherently staged nature of autologous breast reconstruction.

Clinical question/level of evidence: Therapeutic, III.

PubMed Disclaimer

Comment in

References

    1. Holm S. A simple sequentially rejective multiple test procedure. Scand J Stat. 1979;6:65–70
    1. Guerra AB, Metzinger SE, Bidros RS, et al. Bilateral breast reconstruction with the deep inferior epigastric perforator (DIEP) flap: An experience with 280 flaps. Ann Plast Surg. 2004;52:246–252
    1. Hofer SO, Damen TH, Mureau MA, Rakhorst HA, Roche NA. A critical review of perioperative complications in 175 free deep inferior epigastric perforator flap breast reconstructions. Ann Plast Surg. 2007;59:137–142
    1. Mehrara BJ, Santoro TD, Arcilla E, Watson JP, Shaw WW, Da Lio AL. Complications after microvascular breast reconstruction: Experience with 1195 flaps. Plast Reconstr Surg. 2006;118:1100–1109
    1. Alderman AK, Wilkins EG, Kim HM, Lowery JC. Complications in postmastectomy breast reconstruction: Two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2002;109:2265–2274

Publication types