Related Experiment Video
Updated: Jun 29, 2025
13:35
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
2.6K
Continuing Insurance Coverage for Flap-Based Breast Reconstruction: Is There a Reservation Cost Related to a Woman's
Jose A Foppiani1, Erin Kim1, Allan A Weidman1
1From the Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Annals of Plastic Surgery
|April 1, 2024
Summary
Out-of-pocket costs significantly impact breast reconstruction choices. Rising expenses for deep inferior epigastric perforator (DIEP) flaps may limit patient access to preferred reconstructive options.
Area of Science:
- Plastic Surgery
- Health Economics
- Patient-Reported Outcomes
Background:
- Concerns persist regarding insurance coverage for breast reconstruction following proposed CMS regulation changes.
- Understanding patient preferences is crucial for assessing the impact of evolving insurance policies on reconstructive surgery access.
Purpose of the Study:
- To identify factors influencing women's preferences for autologous breast reconstruction methods.
- To evaluate the potential consequences of insurance coverage changes on patient choices.
Main Methods:
- A survey of 485 adult women in the US assessed preferences between deep inferior epigastric perforator (DIEP) and transverse rectus abdominis myocutaneous (TRAM) flaps.
- The Cochrane-Armitage test analyzed flap preference trends with increasing out-of-pocket costs.
Main Results:
- 78% of respondents initially preferred DIEP flaps over TRAM flaps.
- Preference shifted to TRAM flaps as DIEP out-of-pocket costs increased, with an indifference point at $3804.
- Women with prior breast reconstruction experience showed a stronger preference for DIEP, even at higher costs ($10,000).
Conclusions:
- Out-of-pocket expenses are a significant determinant in patients' breast reconstruction decisions.
- Insurance practices increasing DIEP flap costs may reduce equitable access to current reconstructive options.
- Reevaluation of insurance policies is recommended to ensure continued patient access to preferred breast reconstruction techniques.
