Autologous more expensive than implant-based breast reconstruction in medium term

Autologous breast reconstruction achieves comparable operative time and rate of surgical procedures as implant-based reconstructions, a recent study has found. However, medium-term costs are much higher for autologous operations.

Drawing 2008–2019 data from the breast reconstruction database of Tampere University Hospital in Finland, the researchers retrospectively assessed 591 patients who had undergone autologous reconstructions and compared procedural, outcome, safety, and cost factors to 202 patients who underwent implant-based operations.

Both procedures yielded comparable rates of unplanned and planned secondary operations (p=0.098). In particular, most patients in both the implant-based and autologous reconstruction arms needed one secondary operation (64 percent vs 75 percent). Only 9 percent and 6 percent in the corresponding groups needed ≥3 secondary procedures.

Meanwhile, complications occurred significantly more frequently in the implant-based group (p<0.001), an effect driven mainly by minor complications (42 percent vs 25 percent). Fifty-six percent of autologous reconstruction patients saw no complications, as compared with 42 percent of women in the implant-based reconstruction group.

Notably, medium-term costs were significantly higher in the autologous reconstruction group, totaling $22,052 over the 12-year study period, as opposed to only $18,329 in the implant-based group (p<0.001). This effect could be accounted for by the excess costs due to planned visits in the autologous group ($838 vs $597; p<0.001).

“Although our study can be considered to be a medium-term study, it is evident that a full cost assessment of the reconstructive methods would require longer than 10 to 12 years,” the researchers said.

“After that timepoint, revision operations with implants might just start to require capsulectomies and even secondary flap reconstructions. Therefore, a 20-year follow-up period might provide a more accurate assessment of the total costs,” they added.