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Table 3: Patient demographics tumor histology and oncological treatment by procedure
Natrelle™ 150 only (%) Natrelle™ 150 + LD (%) Allergan™ 133 (%) Mentor™ Siltex (%)
Number of patients 34 92 21 11
Frequency of procedures 45 98 28 17
Mean age at implantation 52.6 (20-73) 51.3 (24-68) 49.4 (21-68) 48.9 (30-61)
Mean BMI 28.0 (21-43) 25.7 (18-43) 27.9 (18-38) 24.5 (21-30)
Smokers 7 (21) 11 (12) 2 (9.5) 1 (9.1)
Diabetes 0 2 (2.2) 1 (4.8) 0
ASA 1 = 13 (38) 1 = 46 (50) 1 = 12 (57) 1 = 4 (36)
2 = 19 (56) 2 = 42 (46) 2 = 9 (43) 2 = 7 (64)
3 = 2 (5.9) 3 = 2 (2.2) 3 = 0 3 = 0
4 = 0 4 = 0 4 = 0 4 = 0
Tumor
DCIS 21 (47) 53 (54) 13 (47) 10 (59)
Invasive 28 (62) 74 (76) 15 (54) 14 (82)
NPI range 2.14-6.56 2.06-7.20 2.22-5.52 2.01-5.50
Radiotherapy 2 (4.5) 25 (26) 0 0
Chemotherapy 19 (42) 38 (39) 10 (36) 10 (59)
Hormonal 21 (15) 66 (67) 14 (50) 11 (65)
Neoadjuvant 0 4 (4.1) 0 0
Herceptin 3 (2.1) 8 (8.2) 0 1 (5.9)
LD: Latissimus dorsi, BMI: Body mass index, ASA: American Society of Anaesthesiologists, DICS: Ductal carcinoma in situ, NPI: Nottingham prognostic index

degree of LD atrophy that can ensue. Analyzing all the explanted implants, with the cost of each patient £4,755
other factors, there was no statistical significant difference instead of the stipulated £3,402. Similar analyses have
between the one‑stage procedure group and two‑stage been performed for the Natrelle™ 150 and LD group,
procedure group (P > 0.05). There were insufficient Allergan™ 133 and Mentor™ Siltex groups [Figure 1].
patients with diabetes to make a valid analysis on this Overall cost was analyzed using a Kruskal‑Wallis test
parameter. A Cox regression analysis found that age, body (nonparametric equivalent of an ANOVA) and Mann‑Whitney
mass index, smoking status, radiotherapy, and American U‑test. This shows that the Allergan™ 133 two‑stage
Society of Anaesthesiologist grades were not significantly procedure is the cheapest reconstructive option
associated with higher rates of explantation.
(P < 0.001). The Mentor™ Siltex and Natrelle™ 150 only
Explantation procedure are the most expensive options. We used an
Explantation is the unanticipated removal or exchange of independent sample t‑test to compare the combined
implants secondary to complications. Fifty‑one (36%) of overall costs of the one‑stage procedures to the two‑stage
the Natrelle™ 150 implants were explanted an average procedures and this showed that the one‑stage group was
of 12.9 months after implantation (range: 1‑48 months, significantly more expensive than the planned two‑stage
median: 8.0 months). The majority (40, 79%) were group (P = 0.016).
exchanged for fixed volume silicone implants to improve
esthetics. Other indications were infection (5, 9.8%), DISCUSSION
leak (2, 3.9%) and recurrence of cancer (4, 7.8%).

In the two‑stage reconstruction group, problems can While the material costs of the Natrelle™ 150 is more
likewise develop requiring implant removal or exchange expensive than its comparative expander or silicone
with cost implications. Explantation of the final implant, it is thought to be cost‑effective as it eliminates
fixed volume silicone implants was analyzed. In the the expenses associated with a second operation. However,
Mentor™ Siltex group, one implant was exchanged for any complication resulting in the loss or exchange of this
another prosthesis, 18 months later due to implant implant will essentially convert a one‑stage procedure
migration. In the Allergan™ 133 group, three implants into a two‑stage operation. This includes the additional
were exchanged to improve cosmesis, an average of costs of a second general anesthetic procedure and
19 months after their second stage procedure. replacement of the implant in addition to the original
costs of the Natrelle™ 150 implant. In today’s health
Cost analysis economics, where health care providers are increasingly
Forty percentage of Natrelle™ 150 only implants were required to rationalize expenses, these cost implications
retained with an average length of inpatient stay of merit investigation.
3.78 days gives an average cost of £3,422, close to the
estimated HRG stipulated cost of £3,402. However, 60% There are a growing number of studies analyzing the
[12]
of the Natrelle™ 150 only implants were explanted with costs of various breast reconstructions. [8‑11] Grover et al.
an average total inpatient stay of 4.22 days. There was a compared five methods of breast reconstruction‑autologous
mean unanticipated excess cost of £1,350 in each of these flaps with pedicled tissue, autologous flaps with free

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