CAN THE COST AFFECT THE CHOICE OF VARIOUS METHODS OF POSTMASTECTOMY BREAST RECONSTRUCTION

Aim and background: A wide range of methodologies for breast reconstru ction is now available. For immediate breast reconstruction we prefer to use implants, whereas reconstruction using autologous tissues, such as transverse rectus abdominis musculocutaneous flaps (TRAMF) and mus cular latissimus dorsi flaps, is applied only in selected cases. In co ntrast, for delayed reconstruction the choice between prostheses and a utologous tissue depends on various conditions. The different reconstr uctive methods can be adopted as a single procedure or as a combinatio n of surgical procedures. Following the issue of legislation defining the new structure of the Italian Health Service, the need to accuratel y assess the costs incurred for the execution of surgical operations h as taken on paramount importance. The aim of the study was to evaluate not only the clinical limits of each surgical technique, but also its cost, in order to optimize the choice of the same procedures, conditi ons being equal. Methods: The study population included 105 patients w ho underwent breast reconstruction in the period Ist January 1994-30th June 1995, The reconstructive procedures included 48 immediate implan ts, 7 immediate TRAMF, 17 delayed implants, 30 delayed TRAMF, and 3 de layed latissimus dorsi muscular flaps, Results: After data evaluation, we concluded that reconstruction using permanent expandable implants is the most convenient among implant reconstructions for its low globa l treatment cost. In fact, reconstructive procedures using temporary e xpanders, which require two surgical operations, have a higher cost th an breast reconstruction using permanent expandable implants, Breast r econstruction using TRAMF is the most convenient because it limits the cost of surgical materials and because flap versatility limits the nu mber of modifications on the contralateral breast. In contrast, breast reconstruction using latissimus dorsi flaps has high costs. Conclusio ns: There is no balance between price list and effective cost of the d ifferent surgical reconstructive procedures, which may be a point of d eparture to see whether it is impossible to improve the efficiency of the Health Care System and in any case open a debate between the Regio ns and hospitals to improve the service, keeping it at a good level.