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insertion of the expander and the second to exchange days staged as an inpatient, after which each night will
the expander for a fixed volume silicone implant, once incur an excess cost of £131. This is shown in Table 2.
the expander has reached its ideal size after outpatient Using this method of data analysis, we analyzed length of
injections. [2]
stay and costs incurred in all four procedure groups: the
The Natrelle™ 150 (previously known as the McGhan™ 150) Natrelle™ 150 only procedure group; the Natrelle™ 150 and
was introduced in the 1990s. Like the Becker Siltex, it has latissimus dorsi (LD) procedure group; the Allergan™ 133
an inner chamber of saline outer shell of silicone, and a procedure group and Mentor™ Siltex procedure group. We
remote port. The main difference is that the Becker Siltex specifically calculated the average costs and length of stay
is round, while the Natrelle™ 150 has an anatomical for retained and explanted procedures.
shape, purportedly creating a more natural, teardrop Nonparametric data were analyzed using Chi‑squared and
shape. At present, the Natrelle™ 150 and Becker™ Fisher’s exact tests. Cost was analyzed using independent
range are the only two expander implants on the sample t‑test, Kruskal‑Wallis and Mann‑Whitney U‑tests.
market, available for one‑stage reconstruction, and the SPSS version‑20 was used for all statistical analysis with
Natrelle™ 150 is routinely used at our unit for one‑stage the assistance of a trust‑affiliated statistician.
reconstruction.
The surgical outcomes of the Natrelle™ 150 expander are RESULTS
well known, with many papers endorsing its good surgical
outcomes. [3‑6] However, it is more expensive than a One hundred and forty‑three one‑stage procedures and
comparative tissue expander [Table 1], but deemed to be 45 two‑stage procedures were performed. All patients’
cost‑effective with many savings derived from a one‑stage demographics oncological histology, and treatment by
operation. procedure are shown in Table 3. Chi‑squared analysis
The corollary to this is that any unexpected complication and Fisher’s exact test were used to compare parameters
resulting in loss or exchange of the implant will effectually between these groups. We found that there were a
result in a two‑stage operation. This will incur the cost of significantly higher number of patients in the one‑stage
a second hospital admission, general anesthetic procedure, reconstruction group who received radiotherapy compared
and additional implant over and above the excess material to the two‑stage reconstruction group (P < 0.01). This
cost of the Natrelle™ 150 implant. There is increasing observation is expected as patients who have had
emphasis on good health economics, and to date there radiotherapy are more likely to have a LD flap procedure.
has been no cost analysis study analyzing if expander It is the senior author’s practice to offer permanent
implants are truly cost‑effective. expanders in patients who require LD flaps. This allows
for greater volume to match the contralateral side and
To analyze the costs of one‑stage and two‑stage breast also allows for future alterations, given the unpredictable
reconstructions, taking into account unexpected explantation
as a complication. This will allow us to evaluate the true
cost‑effectiveness of one‑stage reconstruction at a single Table 1: Typical costs of implants in the UK
institution in the UK. Reconstruction Cost
One-stage reconstruction
METHODS Natrelle™ 150 £975
Two-stage reconstruction
A retrospective case note review was carried out on all Expander £599
patients who had undergone one‑stage and two‑stage Fixed volume implant £560
at our unit from 2005 to 2010 by a single oncoplastic Total £1,159
surgeon. The Natrelle™ 150 implant is utilized in our
hospital for one‑stage reconstruction, and the Mentor™ Table 2: Procedures and stipulated costs according to
Siltex and Allergan™ 133 expanders for two‑stage HRG codes
reconstruction. All the patients received a drain in the
breast pocket and remained in hospital until the drains are Procedure Cost and maximum number
of days of inpatient stay
removed. We do not employ the use of dermal substitutes
TM
such as Strattice . All patients who underwent one‑stage Natrelle™ 150 only reconstruction £3,402
and two‑stage reconstruction were included in our Natrelle™ 150 + LD reconstruction 14 days
£3,402
database, and there was no exclusion criterion. 14 days
Cost information was obtained from the financial department Allergan™ 133 first stage £1,148
6 days
and surgical directorate accountant. Each procedure is reconstruction £3,402
Mentor™ Siltex first stage
assigned a Healthcare Resource Group (HRG) code which reconstruction 14 days
[7]
determines the costs incurred. Within the National Health Exchange of expander/expander £1,236
Service (NHS), a HRG is a group consisting of patient implant for fixed volume implant 9 days
events that have been deemed to consume a similar level Additional inpatient stay would incur a daily rate of £131. LD: Latissimus
of resource. This cost is based on a maximum number of dorsi, HRG: Healthcare Resource Group

Plast Aesthet Res || Vol 2 || Issue 6 || Nov 12, 2015 321