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Figure 1: The costs incurred for each type of reconstruction when additional admissions and surgery secondary to explantation are taken into account

tissue, LD flaps with breast implants, expanders with immediate reconstruction were randomly assigned to either
implant exchange and immediate implant placement. They the Natrelle™ 150 or Becker™ Siltex implant. Aesthetic
concluded “that autologous pedicled tissue was slightly outcomes were evaluated by an expert panel who also
more cost‑effective than free tissue reconstruction”, and tried to recognize which implants the breasts were
that “implant based techniques were not cost‑effective”. reconstructed with. The results showed that there was no
Damen et al. compared silicone implants, implants difference between the two groups in terms of symmetry,
[13]
preceded by tissue expansion, LD flaps and deep inferior outcome scores and patient satisfaction. The expert panel
epigastric perforator flaps in 427 patients in a single guessed the right implant shape in 42% of the Natrelle™
Dutch center. They found that immediate one‑stage 150 implants and 66% of the round implants.
reconstructions have lower costs compared with flap There have been a number of studies [15‑18] assessing survival
procedures and tissue expander reconstructions. To of the Becker™ permanent expanders with variable

date, there have been no cost analysis solely comparing results. Taboada‑Suarez et al. reviewed 314 Becker™
[19]
one‑stage and two‑stage reconstruction.
permanent expander’s implants in 237 patients, and found
At present, there are only two expander implants on the “a mean survival time to explantation of 120 months”.
UK market designed for a one‑stage reconstruction: the Farace et al. found that 77 of Becker™ implants were
[20]
Natrelle™ 150 and the Becker™ Siltex. The Natrelle™ removed within 5 years in a cohort of 99 patients.
150 implant is used for one‑stage reconstruction at Goh et al. found an explantation rate of 25% at a mean
[21]
this center because the surgeon has been trained in follow‑up of 64.6 months. There is much less published
its use and is most familiar with this product. There is data on the longevity of the Natrelle™ 150 implant.
no clear benefit of using one expander implant over Gui et al. studied 107 patients with 129 reconstructions
[22]
the other apart from surgeon or patient preference. In with the Natrelle™ 150 and found a low 3.9% explantation
fact, a paper published in November 2010 compared rate at a mean of 18 months. Cicchetti et al. analyzed
[4]
[14]
aesthetic outcome and patient satisfaction between 97 consecutive patients who received a 107 Natrelle™
patients who had received the Natrelle™ 150 implant and 150 expander implants and their data show an overall
Becker Siltex implant. Two groups of patients who were explantation rate of 25% by 6 years. Despite its primary
all undergoing bilateral, prophylactic mastectomy and design of permanent expanders being “permanent”,

Plast Aesthet Res || Vol 2 || Issue 6 || Nov 12, 2015 323