VARIOUS METHODS OF BREAST RECONSTRUCTION AFTER MASTECTOMY - AN ECONOMIC COMPARISON

This study is an economic comparison of various methods of breast reco nstruction after mastectomy. The hospital bills of 287 patients underg oing breast reconstruction at three institutions from June of 1988 to March of 1991 were analyzed. The procedures examined included mastecto my, implant and tissue-expander reconstruction, and TRAM and latissimu s pedicle flaps, as well as free TRAM and free gluteal flaps. These pr ocedures were subdivided into those which were performed at the time o f mastectomy and those performed at a later admission. In addition, au xiliary procedures (i.e., revision, nipple reconstruction, tissue-expa nder exchange, and contralateral mastopexy/reduction) also were examin ed. Where appropriate, these procedures were subdivided into those per formed under general or local anesthesia and by inpatient or outpatien t status. Data from the three institutions were converted to N.Y.U. Me dical Center costs for standardization. A table is presented that summ arizes the costs of each individual procedure with all the pertinent v ariations. In addition, a unique and novel method of analyzing the dat a was developed. This paper describes a menu system whereby other data regarding morbidity, mortality, and revision rates may be superimpose d. With this information, the final cost of reconstruction can be extr apolated and the various methods of reconstruction can be compared. Th is method can be applied to almost any complex series of multiple proc edures. The most salient points elucidated by this study are as follow s: The savings generated by performing immediate reconstruction varies between $5092 (p < 0.05) for free gluteal flaps and $10,616 (p < 0.05 ) for pedicled TRAM flaps. Depending on specific procedure, outpatient surgery offers an approximate $5000 savings as compared with the same procedure performed on an inpatient basis. Lastly, we point out numer ous economic inefficiencies in an effort to lower the financial cost o f the surgical treatment of breast cancer and the subsequent reconstru ction. Among our suggestions are to perform immediate reconstruction w hen medically feasible and acceptable for the patient, to perform outp atient procedures when possible, and to perform multiple procedures wh en technically feasible.