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it is evident from the growing literature that these not included outpatient visits, medications, physiotherapy
expander implants are often removed early secondary to or any unexpected costs from complications other than
[23]
complications. Eriksen et al. performed a prospective, explantation. It is not feasible to factor in these additional
randomized study comparing one‑stage (Becker 25) and costs based on a retrospective study. We are interested
two‑stage reconstruction and found that 70% in the in the rates of explantation and the cost implications
one‑stage group required revision surgery. They concluded resulting from failed one‑stage procedure. Our results
that “the permanent expander method failed significantly show that the cost of one‑stage reconstruction at this
as a one‑stage procedure”. Similarly, Susarla et al. center is significantly more expensive than two‑stage
[24]
compared one‑stage and two‑stage reconstructions and reconstruction.
found that the one‑stage cohort was “80% more likely to Cost implications of varying breast reconstructions are an
require additional operative revisions” compared to the important subject worthy of study and results are highly
two‑stage group. This is an important consideration not relevant to clinical practice. While our methodology for
only for economic reasons, but also for patient selection cost analysis is objective and transferable, we question if
and counseling.
the results reflect the true costs in clinical practice, given
Explantation is the most objective, measurable complication the way the coding system is derived.
and we looked at this in detail. Our data show an overall This is the first study to directly compare the cost of
explantation rate of 36% at a mean of 12.9 months one‑stage versus two‑stage breast reconstruction. We
postimplantation. These results suggest that for a have found that the one‑stage procedure is significantly
significant proportion of patients undergoing planned more expensive than two‑stage reconstruction. This is
one‑stage reconstruction, the Natrelle™ 150 has based on a 36% explantation rate, which is comparable
functioned as a temporary expander.
to other series showing explantation rates ranging
Our analysis of costs involved revealed some surprising from 25% to 70%. There are many benefits of one‑stage
findings, in particular, the operation codes, HRG codes breast reconstruction; however, it does not appear to be
and allocated costs. Vastly differing procedures, while cost‑effective when additional admissions for explantation
using different implants with different expected operating surgery are taken into account.
time, are given the same HRG code and costs. For
example, the LD and Natrelle™ 150 expander procedure Financial support and sponsorship
has the same code as the Natrelle™ 150 only procedure, Nil.
despite the former being much more technically Conflicts of interest
demanding, involving a significantly longer operating There are no conflicts of interest.
time and inpatient hospital stay. The Natrelle™ 150 only
procedure and the Natrelle™ Siltex procedure similarly REFERENCES
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324 Plast Aesthet Res || Vol 2 || Issue 6 || Nov 12, 2015