The cost of major complications associated with immediate two-stage expander/implant-based breast reconstruction

Previous studies assessing the costs associated with two stage expander/implant (E/I) reconstruction rarely include the cost of complications. The purpose of this study is to analyze the complication costs associated with a single institution experience with immediate E/I reconstruction. All immediate two stage E/I reconstructions at a single institution between March 2005-April 2011 were reviewed. The reconstruction database was retrospectively queried for reconstructive details, complications, and cost. Statistical analyses were performed to determine which complications significantly increased reconstructive cost. 327 E/I reconstructions in 195 patients were analyzed. The major complications analyzed included haematoma requiring evacuation (1.2% of reconstructions), major infection (6.1% of reconstructions), E/I exposure (3.1% of reconstructions), and E/I rupture (2.4% of reconstructions); 2.1% of patients experienced reconstructive failure. The mean reconstructive cost was $22,323 ± 9,072. Costs were increased $12,554 by E/I infection (p < 0.001) and $17,153 by prosthetic exposure (p < 0.001). Pre- or postoperative radiation or chemotherapy did not significantly affect reconstructive costs. Unplanned readmissions or unplanned visits to the operative room significantly increased total reconstructive costs (p < 0.001 and p < 0.001, respectively). In conclusion, prosthetic infection and prosthetic exposure significantly increased costs associated with immediate two-stage E/I reconstruction, as did unplanned readmissions and unplanned visits to the operative room. In the current state of the US healthcare system, it is becoming more important for surgeons to be conscious of the economic burden associated with poor reconstructive outcomes.