Comparison of cost for DIEP and free TRAM flap breast reconstructions

A recent article by Kaplan and Alien suggested that deep inferior epigastri c perforator (DIEP) flap breast reconstruction was less expensive than reco nstruction performed with free transverse rectus abdominis musculocutaneous (TRAM) flaps. To test that hypothesis, a series of patients who had underg one unilateral breast-mound reconstruction by the first author using DIEP o r free TRAM flaps between November 1, 1996, and March 30, 2000, were review ed. Bilateral reconstructions and reconstructions performed by other surgeo ns in the department were excluded to eliminate all variables except the ch oice of flap. All hours in the operating room and days in the hospital unti l discharge were included. Early readmissions for the treatment of complica tions were included, as were the costs of the mastectomy in the case of imm ediate reconstructions, but late revisions and nipple reconstructions were not. The totals were then converted into resource costs in 1999 dollars, an d the DIEP and free TRAM flap groups compared. There were 21 DIEP flaps and 24 free TRAM flaps in the series. In this series, there was no significant difference between the cost of DIEP and free TRAM flap breast reconstructi on.