Cost-effectiveness of one-stage versus two-stage breast reconstruction in the United Kingdom

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 centre, 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.

Keywords

Breast reconstruction / cost-effectiveness / latissimus dorsi fap / McGhan^TM 150 expander implant / Natrelle^TM 150 expander implant / one-stage breast reconstruction / permanent tissue expanders

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