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Original Article Plastic and Aesthetic Research

Cost-effectiveness of one-stage versus

two-stage breast reconstruction in the

United Kingdom

Isabel Teo , Iman A. Azmy 2
1
1 Department of Plastic Surgery, St John’s Hospital at Howden, Livingston, West Lothian EH54 6PP, UK.
2 Department of Breast Surgery, Chesterfield Royal Hospital ‑ NHS Foundation Trust, Calow, Chesterfield, Derbyshire S44 5BL, UK.
Address for correspondence: Miss. Isabel Teo, Department of Plastic Surgery, St John’s Hospital at Howden, Livingston, West Lothian EH54 6PP,
UK. E-mail: isabelteo@hotmail.com

ABSTRACT
Aim: Permanent expanders allow for breast reconstruction as a single stage. These prostheses are
more expensive than conventional tissue expanders, but this excess cost is markedly offset as only
one operation is required. However, if the revision rate is sufficiently high, then this effect is negated.
We aim to compare costs of one-stage vs. two-stage reconstruction at a single center, taking into
account explantation and unexpected admissions following complications. Methods: A retrospective
review was carried out on all patients who underwent one-stage and two-stage reconstruction over a
5-year period by a single surgeon. A cost analysis was performed taking into account, explantation and
additional admissions. Results: One hundred and forty-three one-stage and 45 two-stage procedures
were included. The explantation rate for one-stage procedures is 36%, at a mean of 12.9 months
postimplantation, the majority of which were exchanged for silicone implants to improve cosmesis.
Four (9%) of the two-stage procedures were explanted a mean of 18 months postreconstruction. Overall,
one-stage reconstructions were significantly more expensive than the two-stage group (P = 0.016).
Conclusion: There are many benefits of one-stage breast reconstruction. However, it does not appear
to be cost-effective when additional admissions for explantation surgery are taken into account.
Key words:
Breast reconstruction, cost-effectiveness, latissimus dorsi flap, McGhan™ 150 expander implant,
Natrelle™ 150 expander implant, one-stage breast reconstruction, permanent tissue expanders

INTRODUCTION of a saline implant and permit long‑term, noninvasive
adjustment of breast size. Reconstruction can, therefore,
One‑stage reconstruction was introduced in the 1980s be completed as a single procedure. The implant is placed
as a valuable addition to the breast reconstruction at the index procedure, expansion achieved with repeat
armamentarium. The first expander implant, the Becker™ outpatient injections of saline until optimum breast size
Siltex, came onto the market in 1984, this is a round is reached. The traditional two‑stage reconstruction,
[1]
prosthesis with a saline‑filled inner lumen surrounded by however, involves two operations, the first involving the
a silicone gel, connected to a remote port for injection
of saline. These implants provide the volume flexibility This is an open access article distributed under the terms of the Creative Commons
Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix,
Access this article online tweak, and build upon the work non-commercially, as long as the author is credited
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Website: For reprints contact: reprints@medknow.com
www.parjournal.net
How to cite this article: Teo I, Azmy IA. Cost-effectiveness of one-
stage versus two-stage breast reconstruction in the United Kingdom.
DOI:
10.4103/2347-9264.169494 Plast Aesthet Res 2015;2:320-5.
Received: 03-01-2015; Accepted: 24-09-2015

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